Job Summary
A healthcare company is searching for a person to fill their position for a Remote Licensed Utilization Review Nurse I.
Candidates will be responsible for the following:
- Reviewing claim edits, pre-noted inpatient admissions or episodic outpatient therapy
- Conducting pre-certification, inpatient, out of network and appropriateness of treatment
- Referring treatment plans/plan of care to peer clinical reviewers
Must meet the following requirements for consideration:
- Current active unrestricted license or certification to practice as a health professional
- LPN, LVN, or RN
- 2 years of clinical or utilization review experience,
- Or equivalent combination of education and experience
- Must have an understanding of accrediting and regulatory requirements and standards
