Utilization Review Nurse - TX, GA, AZ, FL

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

Key Responsibilities

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

Gather necessary information to assess members' clinical conditions and apply evidence-based guidelines

Refer members for further care engagement and ensure compliance with applicable laws and regulations

Required Qualifications

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

Associate or Bachelor's Degree in Nursing or a graduate of an accredited school of nursing

Experience with MCG or InterQual tooling

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

1+ years of clinical experience in an acute care setting