State Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse to evaluate treatment plans for medical necessity and efficiency.

Key Responsibilities

• Perform pre-certification, concurrent, and retrospective reviews of treatment plans
• Utilize critical thinking to assess coverage for medically necessary healthcare services
• Document and communicate utilization review activities and outcomes effectively

Required Qualifications

• Registered Nurse with a current license to practice in the state of employment
• 2+ years of experience in managed care, Utilization Review, or Case Management
• Knowledge of medical terminology, ICD-9/ICD-10, and CPT
• Proficiency with Microsoft Office applications
• Current compact RN licensure to practice in applicable states