Utilization Review Nurse - TX, GA, AZ, FLVirtualVocations • Buffalo, New York, United States
Utilization Review Nurse - TX, GA, AZ, FL
VirtualVocations • Buffalo, New York, United States
[job_card.1_day_ago]
[job_preview.job_type]
- [job_card.full_time]
[job_card.job_description]
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
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Utilization Review Nurse • Buffalo, New York, United States
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