Utilization Review Appeals Registered Nurse

Location: Remote
Compensation: Hourly
Staff Reviewed: Fri, Feb 09, 2024
This job expires in: 7 days

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

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