Job 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. The ideal candidate will have strong clinical skills, knowledge of healthcare regulations, and a commitment to promoting cost-effective healthcare delivery.

Key Responsibilities

• Review patient medical records to assess the necessity of medical services.
• Apply established criteria and guidelines to determine appropriateness of care.
• Collaborate with physicians and other healthcare providers to optimize patient care.
• Identify opportunities to improve healthcare utilization and reduce costs.
• Maintain accurate and complete documentation of utilization review activities.

Required Skills

• Registered Nurse (RN) license.
• Knowledge of healthcare regulations and guidelines.
• Strong analytical and problem-solving skills.
• Excellent communication and interpersonal skills.