Washington Licensed Utilization Review Nurse

Job Summary

Working remotely in a full-time capacity, the Washington Licensed Utilization Review Nurse will perform medical necessity reviews, consult with Medical Directors, and document clinical information to ensure compliance with established criteria and protocols for various healthcare services.

Key responsibilities

• Conducts medical necessity reviews for inpatient admissions, outpatient services, and benefit applications
• Collaborates with Medical Directors and other departments to ensure appropriate and cost-effective care
• Maintains compliance with accreditation and regulatory requirements while documenting clinical determinations accurately

Required qualifications

• Bachelor's degree or 4 years of relevant work experience
• Current State licensure as a registered nurse
• At least 3 years of clinical experience
• Utilization Management experience (preferred)
• Experience in the health plan industry (preferred)