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RN Utilization Review ClinicianVirtualVocations • Chesapeake, Virginia, United States
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RN Utilization Review Clinician

RN Utilization Review Clinician

VirtualVocations • Chesapeake, Virginia, United States
30+ days ago
Job type
  • Full-time
Job description
Working remotely on a full-time basis, the RN Utilization Review Clinician will assess clinical service requests to ensure medical necessity, compliance with guidelines, and optimal member outcomes, with a requirement to work on Saturdays. Key responsibilities Assess services for members to ensure compliance with state and federal regulations and guidelines Analyze clinical service requests against evidence-based clinical guidelines and determine prior authorization needs Collaborate with multidisciplinary teams to promote effective care delivery and make appropriate referrals to clinical programs Required qualifications At least 2 years of experience in hospital acute care, inpatient review, or managed care Active and unrestricted Registered Nurse (RN) license in the state of practice Proficiency in Microsoft Office and applicable software programs Ability to prioritize and manage multiple deadlines effectively Strong organizational, problem-solving, and critical-thinking skills
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RN Utilization Review Clinician • Chesapeake, Virginia, United States

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