Utilization Review RN

📋 Description

• Conduct clinical reviews of inpatient admissions, observation stays, and continued hospital stays
• Identify potential overutilization or underutilization of healthcare services and refer cases to
• Collaborate with physicians, care managers, and interdisciplinary teams to clarify clinical
• Complete and submit clinical reviews for commercial insurance carriers within required timeframes
• Maintain documentation to minimize claim denials, coordinate peer-to-peer discussions and appeals
• Work with financial clearance and business office teams to resolve billing concerns and support

🎯 Requirements

• Bachelor's degree in nursing or related field, or equivalent experience.
• Current, unrestricted Registered Nurse (RN) license; active multistate compact RN license preferred
• Three years of nursing experience in acute care setting preferred.
• Previous experience in utilization review, discharge planning, or medical necessity assessments
• Working knowledge of medical necessity review criteria and payer guidelines preferred.
• Working knowledge of healthcare quality improvement processes.

🎁 Benefits

• Annualized salary range of $63,100–$94,650, depending on experience and qualifications.
• Part-time scheduling options of approximately 20 or 24 hours per week with flexible shift
• Weekend differential of 10% for eligible hours.
• Evening shift differential of 10% for eligible hours between 12:00 p.m. and 10:00 p.m.
• Combined premium pay up to 20% for eligible weekend evening shifts.
• Comprehensive benefits package supporting physical, emotional, and financial well-being.