Tennessee RN Utilization Review

Job Summary

To provide timely, evidence-based utilization review services, the full-time Tennessee RN Utilization Review will manage clinical assessments, evaluate treatment plans, and collaborate with healthcare professionals in a remote work environment.

Key responsibilities

• Perform clinical assessments and evaluate patient conditions, including treatment utilization and compliance
• Negotiate appropriate levels of care using medical and disability guidelines while adhering to quality assurance standards
• Consult with clients, nursing staff, and claims examiners regarding treatment issues and maintain client confidentiality

Required qualifications

• Active unrestricted RN license in a state or territory of the United States; compact licensure preferred
• Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred
• Certification in case management, pharmacy, rehabilitation nursing, or a related specialty is highly preferred
• Two (2) years of direct clinical experience as an RN is required