Registered Nurse Utilization Review
Job Summary
To support effective patient management, the full-time Registered Nurse Utilization Review will conduct initial and concurrent reviews of medical records to ensure authorization, optimize reimbursement, and prevent payment denials while working remotely.
Key responsibilities
- Reviews and evaluates clinical information to support Utilization Management decisions based on medical record documentation
- Facilitates communication with payors regarding medical necessity and manages the authorization process in a patient-centered manner
- Collaborates with interdisciplinary teams to prevent and manage concurrent denials and advocates for patients with insurance companies
Required qualifications
- Current Registered Nurse license issued by the state or a multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC)
- Three years of healthcare clinical experience
- Bachelor's Degree in Nursing, Associate of Science in Nursing, or currently enrolled in a BSN program with completion within three years of hire
- Experience in medical management for Medicare and/or Medicaid populations
- Utilization Management experience
Complete Job Description
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