Utilization review nurse [h1.location_city]
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Utilization review nurse • huntsville al
- [promoted]
- [new]
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VirtualVocationsHuntsville, Alabama, United States- [job_card.full_time]
A company is looking for a Concurrent Utilization Review Nurse (Work from Home).
Key Responsibilities
Conduct real-time clinical reviews to assess medical necessity and appropriateness of healthcare services
Collaborate with the Medical Director on complex cases and manage authorization requests
Ensure compliance with health plan policies and maintain accurate documentation of review activities
Required Qualifications
Registered Nurse (RN) with an active, unrestricted California nursing license; BSN preferred
2-3 years of clinical nursing experience, with at least 1 year in utilization review or case management
Experience in a managed care setting is strongly preferred
Preferred certifications include Certified Professional in Utilization Review (CPUR) or Certified Case Manager (CCM)
Strong knowledge of clinical guidelines and medical necessity criteria