South Carolina Licensed Utilization Nurse

Job Summary

A company is looking for a Utilization Management Nurse II.

Key Responsibilities

• Conduct utilization reviews to assess the appropriateness of patient care based on illness severity and service intensity
• Monitor patient charts and treatment plans to ensure compliance with regulatory requirements and insurer approvals
• Collaborate with multidisciplinary teams to communicate review results and optimize hospital resource utilization for reimbursement

Required Qualifications, Training, and Education

• Bachelor's degree in Nursing from an accredited school
• Five years of nursing experience, including two years in utilization or case management in a hospital setting
• Licensure as a registered nurse in South Carolina or a compact state
• Preferred prior leadership experience and committee involvement in a healthcare setting
• Familiarity with InterQual and/or MCG screening criteria is desired