New York Licensed Utilization Review Nurse

A company is looking for a Utilization Review Nurse.

Key Responsibilities

Review health care services for medical necessity and effectiveness through evidence-based criteria

Collaborate with physician peer reviewers and medical directors on service coverage decisions

Maintain documentation compliance and support quality improvement initiatives

Required Qualifications

Current unrestricted NYS RN license

BSN required; advanced degree preferred

2+ years of utilization review experience in a Managed Care Organization or Health Plan

Knowledge of Medicaid and / or Medicare regulations and coverage guidelines

Inpatient experience required; MLTC and Hospital / SNF experience preferred