Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Perform prospective, concurrent, and retrospective reviews of medical services to ensure medical necessity and appropriate care levels
• Analyze and prepare documentation for retrospective review requests and appeals according to regulatory standards
• Coordinate discharge planning and resolve issues related to member benefits and care coordination

Required Qualifications

• Current unrestricted Registered Nurse license
• Minimum of 2 years of clinical experience, including acute care and utilization review
• Health insurance plan or managed care experience preferred
• Certification in Case Management preferred or encouraged
• Demonstrated clinical knowledge of healthcare delivery processes