Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Registered Nurse to join their Clinical Review team.

Key Responsibilities

• Complete medical necessity and level of care reviews using clinical judgment and 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 laws and regulations

Required Qualifications, Training, and Education

• Active, unrestricted RN licensure from the United States or a compact multistate RN license
• Associate Degree in Nursing or equivalent from an accredited school
• 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
• Ability to obtain additional state licenses as needed