RN Utilization Review

Job Summary

A company is looking for an RN Utilization Review.

Key Responsibilities

• Participates in designated committees and task forces related to the Utilization Management (UM) Program
• Coordinates with various departments and medical staff on case management issues
• Documents and communicates quality concerns related to members to the Quality Management staff

Required Qualifications

• Associate or Bachelor's Degree in Nursing
• Current license to practice as a Registered Nurse in the home state or a compact nursing license
• 5-7 years of clinical nursing experience, with at least 2 years in utilization review or case management
• Experience in an HMO insurance setting is preferred
• Ability to analyze and report on medical utilization and audit results