Utilization Management RN Reviewer

Job Summary

A company is looking for a Utilization Management Nurse Reviewer.

Key Responsibilities

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines
• Examine and evaluate patient records to verify the quality of patient care and necessity of services provided
• Provide clinical expertise and manage essential clinical details within various medical management platforms

Required Qualifications

• Licensed Practical/Vocational Nurse with an active and unrestricted license or a nursing degree from an accredited college
• A minimum of 2 years of clinical nursing experience and 1 year of experience in Utilization Management
• Background in medical or clinical practice through education, training, or professional engagement
• Proficient in Microsoft tools such as Word, Excel, PowerPoint, and Outlook
• Ability to maintain professional communication with healthcare providers and clients