Telecommute Utilization Review Nurse

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