DC Licensed Utilization Nurse Reviewer

A company is looking for a Utilization Nurse Reviewer (Remote).

Key Responsibilities

Conduct timely clinical chart reviews and communicate effectively with third-party payers

Review admission service requests for medical necessity and compliance with reimbursement policies

Promote quality care by analyzing hospital resource utilization and suggesting improvements

Required Qualifications and Education

3-5 years of experience in acute care case management or utilization management activities

Knowledge of InterQual / Milliman criteria and CMS guidelines

Current RN-BSN preferred, RN-AA acceptable; DC or MD license required as applicable

Maintains current knowledge / certification in Utilization Management / Case Management

Strong computer skills, including typing 50+ wpm