Ohio Licensed RN Utilization Review - job 1 of 2

Job Summary

A company is looking for an RN Utilization Review.

Key Responsibilities

• Identifies treatment plan requests and analyzes supporting medical records
• Utilizes evidence-based criteria for utilization review determinations and negotiates treatment plans as necessary
• Documents review outcomes and collaborates with claim examiners to resolve clinical issues

Required Qualifications, Training, and Education

• Active unrestricted RN license in a state or territory of the United States
• Bachelor's or Associate degree from an accredited college or university preferred
• Utilization review based certification strongly preferred
• Four years of related experience or equivalent combination of education and experience, including two years of recent clinical practice or one year of recent utilization review