State Licensed Utilization Review Nurse
Job Summary
To provide timely, evidence-based utilization review services, the full-time State Licensed Utilization Review Nurse will analyze treatment plan requests, clarify unclear requests with providers, and utilize evidence-based criteria to determine approvals, all while working remotely.
Key responsibilities
- Identifies and analyzes treatment plan requests and supporting medical records
- Utilizes evidence-based criteria to form utilization review determinations and negotiates with providers as necessary
- Documents utilization review outcomes in software and collaborates with claim examiners to resolve issues
Required qualifications
- Active unrestricted RN license in a state or territory of the United States
- Associate degree from an accredited college or university; Bachelor's degree preferred
- Utilization review-based certification preferred
- Four years of related experience, including two years of recent clinical practice or one year of recent utilization review
Complete Job Description
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