Registered Nurse Utilization Review
Job Summary
Providing first-level admission and continued stay case reviews, the full-time Registered Nurse Utilization Review will work remotely to assess cases using client-specific guidelines and evidence-based criteria while ensuring appropriate clinical documentation and orders are in place.
Key responsibilities:
- Perform initial admission and continued stay reviews utilizing InterQual and MCG evidence-based criteria
- Abstract data from medical records to ensure accurate clinical information
- Communicate effectively with internal and external stakeholders while delivering excellent customer service
Required qualifications:
- Current Registered Nurse license in the state of residence
- Bachelor's Degree
- At least 2 years of recent hospital-based Utilization or Case Management experience preferred
- At least 3 years of clinical nursing experience
- Knowledge of current Medicare rules and regulations related to Utilization Review
Complete Job Description
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