Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Perform prospective, concurrent, and retrospective reviews of services to ensure medical necessity and appropriate care levels
• Analyze and prepare documentation related to retrospective review requests and appeals in compliance with regulatory standards
• Coordinate discharge planning needs and communicate with internal and external entities

Required Qualifications, Training, and Education

• Current unrestricted Registered Nurse license
• Preferred certification in Case Management based on department assignment
• Two to four years of clinical experience in areas such as acute patient care or utilization review
• One year of experience in a health insurance plan or managed care environment preferred
• Knowledge of applicable accreditation standards and regulations