Utilization review nurse Jobs in Raleigh, NC

A company is looking for a Registered Nurse Utilization Review Full Time Days. Key Responsibilities Facilitate effective resource coordination for optimal patient health and access to care Manage the medical necessity process for accurate and timely payment for services Ensure compliance with regulatory requirements and provide education related to covered services Required Qualifications, Training, and Education Associate's Degree or College Diploma Experience in utilization management and medical necessity processes Knowledge of state and federal regulatory requirements Understanding of TJC accreditation standards Ability to negotiate with payers on a case-by-case basis