Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Review medical records and Medicare appeal case files
• Prepare clear, concise, and impartial reconsideration decision letters
• Make independent medical necessity determinations using clinical evidence and Medicare guidelines

Required Qualifications

• Associate's degree or higher in Healthcare (or equivalent experience)
• 3+ years of experience in Medicare appeals, utilization review, medical review, or clinical review
• Clinical background as RN, PT, RT, or OT
• Experience with medical necessity decision making
• Strong written and analytical skills