Job Summary
An insurance company is seeking a Telecommute Utilization Review Nurse.
Individual must be able to fulfill the following responsibilities:
- Work on utilization management and utilization review for prospective reviews
- Perform reviews of services, and determine medical appropriateness outpatient services following evaluation of medical guidelines
- Meet required decision-making timeframes, including promptly triggering escalation for cases requiring physician review
Qualifications for this position include:
- Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license
- Associate Degree - Nursing or Graduate of Accredited School of Nursing
- Must obtain additional state licenses as needed for growth
- One year of utilization review experience in a managed care setting
- Two or more years clinical experience
- Experience with medical decision support tools
