State Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse to join their Utilization Review team.

Key Responsibilities

Complete medical necessity reviews and level of care reviews using clinical judgment

Obtain necessary information to assess a member's clinical condition and apply evidence-based guidelines

Meet required decision-making SLAs and refer members for further care engagement when needed

Required Qualifications

Active, unrestricted RN licensure from the United States or compact multistate unrestricted RN license

Associate Degree in Nursing or equivalent from an accredited nursing program

Ability to obtain additional state licenses as needed

1+ year of utilization review experience in a managed care setting

1+ years of clinical experience, including at least 1+ year in an acute care setting