Job Summary
A healthcare staffing and recruiting firm has an open position for a Remote Utilization Review Registered Nurse.
Candidates will be responsible for the following:
- Utilizing clinical skills to telephonically provide and facilitate utilization review
- Performing reviews of services, and determine medical appropriateness of inpatient and outpatient services
- Obtaining the information necessary to assess a member's clinical condition
Must meet the following requirements for consideration:
- 5 years acute care clinical nursing experience is required
- Current, valid, and unrestricted state Registered Nurse (R.N.) license in a compact state
- Experience using Milliman or InterQual criteria for medical necessity, setting and level of care, and concurrent patient management
- 2 year of recent experience in Utilization Review or Utilization Management at a Health Plan or other Managed Care Organization
- Computer skills to include Microsoft Word, Excel, database use, and basic data entry
