Utilization Review Nurse RN

Job Summary

A company is looking for a Utilization Review Nurse RN (Part-Time).

Key Responsibilities

• Provide assessments and reviews for the medical necessity of treatment requests and plans
• Conduct first level reviews for outpatient and inpatient pre-certification requests, ensuring proper referrals as needed
• Complete documentation for all reviews and maintain compliance with HIPAA and company policies

Required Qualifications

• Current RN license in the United States or U.S. territory
• Associate's degree or diploma from a nursing program required
• Minimum of 1 year of clinical experience required
• Ability to meet productivity, quality, and turnaround times daily
• Ability to pass external audits including URAC and NCQA