Utilization Review Nurse

📋 Description

• Complete medical necessity and level of care reviews using guidelines
• Obtain information via phone and fax to assess clinical condition
• Apply evidence-based guidelines to care decisions
• Meet required decision-making SLAs
• Refer members for further care engagement when needed
• Compliance with applicable laws and regulations

🎯 Requirements

• Active, unrestricted RN license in the US (state) or compact multistate license per NLC
• Associate degree in nursing or nursing diploma; or PN diploma from accredited school
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in managed care
• Strong experience utilizing Milliman Care Guidelines (MCG)
• 1+ year of clinical experience in acute care (ER or hospital)

🎁 Benefits

• Medical, dental, and vision benefits
• 15 days of vacation per year
• 401(k) plan participation
• Life and disability insurance
• Paid holidays and sick time
• Parental leave