Overview

We are seeking a detail-oriented and experienced Utilization Review Nurse to ensure the appropriate and efficient use of healthcare resources. The Utilization Review Nurse will review patient medical records, assess the necessity and appropriateness of medical services, and collaborate with healthcare providers to optimize patient outcomes. This role requires strong clinical knowledge, analytical skills, and a commitment to promoting cost-effective healthcare.

Key Responsibilities

• Review patient medical records to assess the necessity and appropriateness of medical services.
• Apply established criteria and guidelines to determine the medical necessity of services.
• Collaborate with healthcare providers to ensure efficient and effective use of resources.
• Identify and resolve issues related to utilization management.
• Maintain accurate and up-to-date records of utilization review activities.

Required Skills

• Valid RN license.
• Strong clinical knowledge and analytical skills.
• Familiarity with utilization review processes and guidelines.
• Excellent communication and interpersonal skills.