Utilization Review Appeals Registered Nurse

Job Summary

A company is looking for a Utilization Review Appeals Registered Nurse for a remote position.

Responsibilities:

• Complete medical necessity and level of care reviews using clinical judgment and established guidelines
• Obtain necessary information to assess a member's clinical condition and apply evidence-based guidelines
• Refer members for further care engagement when needed and ensure compliance with applicable laws and regulations

Qualifications:

• Active, unrestricted RN licensure in the United States or active compact multistate unrestricted RN license
• Associate Degree in Nursing or Graduate of Accredited School of Nursing or successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing
• Ability to obtain additional state licenses as required
• 1+ year of utilization review experience in a managed care setting
• 2+ years of clinical experience, including at least 1 year in an acute care setting