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Author: Umsebenzi Remote JOBS
A company is looking for a Utilization Review Registered 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 a member’s clinical condition and apply evidence-based guidelines
Refer members for further care engagement when needed and ensure compliance with laws and regulations
Required Qualifications, Training, and Education
Active, unrestricted RN licensure from the United States or a compact multistate RN license
Associate Degree in Nursing or equivalent from an accredited school
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
Ability to obtain additional state licenses as needed
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