Tennessee Licensed Clinical Utilization Review Specialist

Job Summary

A company is looking for a PRN Clinical Utilization Review Specialist responsible for evaluating hospital services for compliance with utilization management policies.

Key Responsibilities

• Conducts admission and continued stay reviews to ensure appropriate utilization of hospital services
• Collaborates with healthcare providers to obtain necessary documentation and supports denials and appeals activities
• Monitors adherence to utilization review plans and analyzes trends to identify process improvement opportunities

Required Qualifications

• Associate Degree in Nursing required; Bachelor's Degree in Nursing preferred
• 2-4 years of clinical experience in utilization review, case management, or acute care nursing required
• 1-3 years work experience in care management preferred
• 1-2 years of experience in utilization management, payer relations, or hospital revenue cycle preferred
• RN - Registered Nurse - State Licensure required