Job Summary
A nonprofit mutual insurance company needs applicants for an opening for a Remote RN Utilization Review Analyst Associate.
Must be able to:
- Perform pre-payment, post-payment or concurrent claims review analysis
- Facilitate and promote appropriate utilization review toward cost effective and cost containment measures based on evidence
- Assess and evaluate the efficiency and appropriateness of services for medical necessity through interpretation and review with evidenced-based criteria, clinical guidelines, corporate guidelines and policies and mandates and standards
Must meet the following requirements for consideration:
- Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred
- Four (4) years of clinical practice nursing experience required, with experience preferred, but not limited to one of the following areas: medical-surgical nursing, surgical nursing, intensive care or critical care nursing
- Proficiency using basic computer skills in Microsoft Office such as Word, Excel, Outlook, and PowerPoint, including the ability to navigate multiple systems and keyboarding
- Experience in utilization review and/or medical review preferred
- Current Unrestricted Registered Nurse License
- Ability to prioritize and make sound nursing judgments through critical thinking
