Utilization Review Nurse

📋 Description

• Perform frequent case reviews, check medical records and speak with care providers regarding
• Make recommendations regarding the appropriateness of care for identified diagnoses based on the
• Complete medical necessity reviews and level of care reviews for requested services using clinical
• Obtain the information necessary (via telephone and fax) to assess a member's clinical condition
• Meet required decision-making SLAs
• Refer members for further care engagement when needed

🎯 Requirements

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate
• Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• Strong experience utilizating MCG (Milliman Care Gudielines) or InterQual
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care

🎁 Benefits

• Employee benefits
• Monthly vacation accrual at a rate of 15 days per year
• Medical, dental, and vision benefits
• 11 paid holidays
• Paid sick time
• Paid parental leave