Utilization Review Nurse - TX, GA, AZ, FL

Job Summary

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

Key Responsibilities

• Complete medical necessity and level of care reviews using clinical judgment and established guidelines
• Gather necessary information to assess members' clinical conditions and apply evidence-based guidelines
• Refer members for further care engagement and ensure compliance with applicable laws and regulations

Required Qualifications

• Active, unrestricted RN licensure from the United States or a compact multistate unrestricted RN license
• Associate or Bachelor's Degree in Nursing or a graduate of an accredited school of nursing
• Experience with MCG or InterQual tooling
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience in an acute care setting