Registered Nurse Utilization Review

Job Summary

Performing medical record reviews for severity of illness and intensity of service, the part-time Registered Nurse Utilization Review will liaise with external review agencies to ensure compliance with regulations affecting financial reimbursement while documenting variances from established pathways in a remote setting.

Key responsibilities:

• Collect information from clinical medical records and document severity of illness and intensity of service in the clinical database
• Monitor levels of care for appropriateness, communicate variances, and evaluate care plans based on accepted standards
• Provide information to external review organizations and refer patients not meeting criteria to designated physician advisors

Required qualifications:

• Current Registered Nurse (RN) licensure
• BSN preferred with 2-5 years of previous Utilization Review experience
• Current CPR certification
• Experience in hospital nursing, hospital case management, insurance case management, or utilization management preferred
• Knowledge of clinical norms and effective time management skills