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 medical records, assess the necessity and appropriateness of medical services, and collaborate with healthcare providers to optimize patient outcomes. The ideal candidate will have a strong clinical background and knowledge of utilization management principles.

Key Responsibilities

• Review 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.
• Identify opportunities to improve the efficiency of healthcare services.
• Maintain accurate and complete documentation of utilization review activities.

Required Skills

• Utilization Management
• Medical Record Review
• Clinical Assessment
• Healthcare Regulations