Utilization Review RN

Location: Remote
Compensation: Base+commission
Staff Reviewed: Mon, Nov 25, 2024
This job expires in: 19 days

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

COMPLETE JOB DESCRIPTION

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