Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Conducts prospective, concurrent, and retrospective utilization reviews for inpatient and outpatient services
• Evaluates member needs at the time of inpatient admission and prioritizes cases to meet CMS standards
• Maintains accurate records of utilization review activities and ensures compliance with regulations

Required Qualifications

• Licensed RN or LPN required
• Minimum of two to three years of varied clinical experience
• Managed care experience preferred
• Equivalent combination of education, training, and experience accepted
• InterQual experience helpful