Washington Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse RN, Post-Acute - Remote in Pacific Time Zone.

Key Responsibilities:

• Conducts clinical reviews for inpatient admissions and preauthorization requests based on medical necessity criteria
• Documents clinical reviews and decisions in the care management system accurately and timely
• Collaborates with the Medical Management team to coordinate care for members and prepares cases for review with Physician Leadership

Required Qualifications:

• Current unrestricted Registered Nurse (RN) license in state of residence
• 2+ years of clinical nursing experience in a Skilled Nursing Facility (SNF)
• Experience in quality case management, utilization review, and quality improvement
• Intermediate proficiency in computer software applications, including Microsoft Word and Excel
• Ability to work Monday-Friday 8am-5pm in Pacific Time Zone and participate in weekend and holiday rotation