Tennessee Licensed Clinical Utilization Review Specialist

Job Summary

To support efficient patient care, the part-time PRN Clinical Utilization Review Specialist will evaluate hospital service necessity and appropriateness, conduct admission and continued stay reviews, and collaborate with healthcare providers remotely.

Key responsibilities

• Perform admission and continued stay reviews using evidence-based criteria and regulatory guidelines
• Collaborate with clinical teams to obtain necessary documentation for medical necessity and payer requirements
• Document utilization review activities in case management software and analyze trends to enhance utilization management

Required qualifications

• Technical School in Practical Nursing or Associate Degree in Nursing required
• 2-4 years of clinical experience in utilization review, case management, or acute care nursing required
• 1-3 years of work experience in care management preferred
• 1-2 years of experience in utilization management or payer relations preferred
• LPN or RN State Licensure required