Registered Nurse Medical Review Specialist
Job Summary
Working remotely in a full-time capacity, the Registered Nurse Medical Review Specialist will conduct utilization reviews to assess the medical necessity of hospital admissions and outpatient procedures, ensuring compliance with established standards and guidelines.
Key responsibilities
- Perform preadmission and concurrent reviews to determine medical necessity for hospital stays and outpatient services
- Communicate with healthcare providers and patients regarding utilization management requirements and decisions
- Document and report findings, maintaining accurate program data and adhering to quality management protocols
Required qualifications
- Current unrestricted Registered Nurse license in the state of practice
- Associate's degree in nursing; bachelor's degree preferred
- Minimum of 5 years of varied clinical nursing experience
- Proficiency in MS Office Suite (Word, Excel, PowerPoint)
- Knowledge of URAC standards and state certification requirements
Complete Job Description
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