Utilization Review RN - job 1 of 5

Job Summary

A company is looking for a Utilization Review Nurse to join their Clinical Review team.

Key Responsibilities

• Complete medical necessity and level of care reviews using clinical judgment and guidelines
• Obtain necessary information to assess members' clinical conditions and apply evidence-based guidelines
• Refer members for further care engagement and ensure compliance with applicable laws and regulations

Required Qualifications

• Active, unrestricted RN licensure from the United States or a compact multistate unrestricted RN license
• Associate Degree in Nursing or graduation from an accredited school of nursing
• Ability to obtain additional state licenses as needed
• 1+ year of utilization review experience in a managed care setting
• 2+ years of clinical experience, including at least 1+ year in an acute care setting