Utilization Management Nurse Reviewer

Job Summary

A company is looking for a Utilization Management Nurse Reviewer (RN/LPN).

Key Responsibilities

• Conduct assessments of medical services to validate appropriateness and necessity using established criteria and guidelines
• Examine patient records to verify quality of care and necessity of services provided
• Provide clinical expertise and serve as a reference for non-clinical staff

Required Qualifications, Training, and Education

• Licensed Practical/Vocational Nurse or Registered Nurse with an active and unrestricted license
• Minimum of 2 years clinical nursing experience required
• At least 1 year of previous experience in Utilization Management required
• Background in medical or clinical practice through education, training, or professional engagement
• Proficient with Microsoft tools such as Word, Excel, PowerPoint, and Outlook