Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Review and evaluate clinical information to support Utilization Management decisions
• Communicate medical necessity to payors and facilitate the authorization process
• Collaborate with interdisciplinary teams to manage concurrent denials and optimize reimbursement

Required Qualifications

• Current Registered Nurse license in the state of practice or multi-state RN license through eNLC
• Three years of healthcare clinical experience
• Bachelor's Degree in Nursing or currently enrolled in a BSN program with completion within three years preferred
• Experience in medical management for Medicare and/or Medicaid populations preferred
• Experience in Utilization Management preferred