Job Summary
A healthcare company needs applicants for an opening for a Remote Utilization Review Nurse.
Candidates will be responsible for the following:
- Performing reviews of services, and determine medical appropriateness of inpatient and outpatient services
- Utilizing clinical skills to telephonically provide and facilitate utilization review
- Identifying ongoing clinical care needs
Position Requirements Include:
- Current, valid, and unrestricted state Registered Nurse (R.N.) or License Practical Nurse (L.P.N.) license
- 2 years acute care clinical nursing experience is required
- Knowledge of guidelines for Medicaid/Medicare and related state programs is required
- 1 year of recent experience in Utilization Review or Utilization Management at a health plan or other managed care organization (HMO/TPA/IPA/etc)
