Utilization Review Nurse, RN

Job Summary

A company is looking for a Part Time Utilization Review Nurse, RN.

Key Responsibilities

• Provide professional assessment and review for medical necessity of treatment requests and plans
• Conduct first level reviews for outpatient pre-certification requests and inpatient hospital stays
• Process appeals for non-certification of services and maintain documentation for all reviews

Required Qualifications, Training, and Education

• Current RN license in the United States or U.S. territory
• 1+ years of clinical experience required
• Knowledge of medical claims and ICD-10, CPT, HCPCS coding
• Proficiency in Microsoft Office applications