State Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Identifies and analyzes treatment plan requests and associated medical records
• Utilizes evidence-based criteria to make utilization review determinations and negotiates with providers as necessary
• Documents outcomes in software and collaborates with claim examiners to resolve clinical issues

Required Qualifications, Training, and Education

• Active unrestricted RN license in a state or territory of the United States
• Associate degree from an accredited college or university required; Bachelor's degree preferred
• Utilization review certification preferred
• Four years of related experience, including two years of recent clinical practice or one year of recent utilization review