State Licensed Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Assure effective communication of medical necessity to applicable payors
• Review and evaluate clinical information to support Utilization Management decisions
• Collaborate with interdisciplinary teams to optimize reimbursement and manage concurrent denials

Required Qualifications

• Current Registered Nurse license issued by the state or multi-state RN license through the eNLC
• Three years of healthcare clinical experience
• Bachelor's Degree in Nursing or Associate of Science in Nursing Degree, or currently enrolled in a BSN program
• Experience in Medical Management for Medicare and/or Medicaid populations is preferred
• Utilization Management experience is preferred