Utilization Review RN - job 1 of 2

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Perform prospective, concurrent, and retrospective reviews of medical services to ensure medical necessity and appropriate care levels
• Analyze and prepare documentation for retrospective review requests and appeals in compliance with regulations and accreditation standards
• Coordinate discharge planning and facilitate communication with internal and external entities regarding patient care needs

Required Qualifications

• Current unrestricted Registered Nurse license
• Minimum of 2 years' clinical experience in areas such as acute patient care or case management
• Preferred certification in Case Management or progress toward certification
• Minimum of 1 year of experience in a health insurance plan or managed care environment
• Demonstrated clinical knowledge relevant to patient care and healthcare delivery processes