Tennessee Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse (RN).

Key Responsibilities

• Identifies and analyzes treatment plan requests and medical records
• Utilizes evidence-based criteria for utilization review determinations and negotiates treatment plans as necessary
• Documents outcomes in software and collaborates with claim examiners to resolve clinical issues

Required Qualifications

• Active unrestricted RN license in a U.S. state or territory
• Associate degree from an accredited college or university; Bachelor's degree preferred
• Four years of related experience, including two years of recent clinical practice or one year of recent utilization review
• Utilization review based certification preferred