Registered Nurse Utilization Review

Job Summary

To support a mission-driven healthcare organization, the full-time Registered Nurse Utilization Review will perform utilization review processes, assess clinical documentation, and establish collaborative relationships with clients and providers while working remotely.

Key responsibilities

• Perform all aspects of the Utilization Review Process, including reviewing records and requests
• Utilize evidence-based guidelines to determine authorization for services and document findings in the database
• Establish collaborative relationships with clients, patients, and providers, while tracking ongoing UR activity

Required qualifications

• An Associate's or Bachelor's degree in Nursing
• Active and unencumbered RN license in one or more states
• 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
• Experience with Workers' Compensation, short-term or long-term disability, or liability claims
• General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines