Utilization Review RN
Job Summary
Providing timely and evidence-based utilization review services, the full-time Utilization Review RN will work remotely to manage complex medical conditions, treatment planning, and recovery for injured employees while advocating for effective medical treatment.
Key responsibilities
- Perform clinical assessments and evaluate patient conditions, treatment utilization, and compliance
- Collaborate with physicians, claims examiners, and other stakeholders to negotiate appropriate care levels
- Maintain client confidentiality and adhere to ethical, legal, and regulatory standards while performing utilization management reviews
Required qualifications
- Active unrestricted RN license in a state or territory of the United States; compact licensure preferred
- Bachelor's degree in nursing (BSN) from an accredited institution or equivalent work experience preferred
- Certification in case management, pharmacy, rehabilitation nursing, or a related specialty is highly preferred
- Two (2) years of direct clinical experience as an RN is required
Complete Job Description
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