Job Summary

A company is looking for a Utilization Review Registered Nurse.

Key Responsibilities:

• Perform initial, concurrent, and post-service review activities, discharge care coordination, and assist with efficiency and quality assurance of medical necessity reviews
• Serve as a liaison between providers/facilities and support the care management model
• Adhere to utilization management productivity metrics, quality standards, and documentation requirements

Required Qualifications:

• Graduate of an accredited school of nursing with a current RN license
• Minimum of 3 years clinical experience and 2 years utilization management experience
• Experience with clinical denials and knowledge of clinical guidelines/criteria
• Ability to make independent decisions, work under deadlines, and provide clear updates
• Familiarity with medical records assembly and clinical terminology