Washington Licensed Utilization Review Nurse

Job Summary

Evaluating clinical requests to determine medical appropriateness, the full-time Washington Licensed Utilization Review Nurse will conduct medical necessity reviews, consult with Medical Directors, and collaborate with various teams while working remotely.

Key responsibilities

• Conduct medical necessity reviews for inpatient admissions, outpatient services, and prior authorizations to ensure alignment with clinical criteria and policies
• Consult with Medical Directors regarding care that does not meet clinical criteria or medical policies
• Document clinical information accurately and maintain compliance with accreditation and regulatory requirements

Required qualifications

• Bachelor's degree or four years of relevant work experience
• Current state licensure as a Registered Nurse
• Three years of clinical experience
• Utilization Review experience (preferred)
• Experience in the health plan industry (preferred)