Overview
We are seeking a detail-oriented Utilization Review Nurse to ensure the appropriateness and medical necessity of healthcare services. The Utilization Review Nurse will review patient medical records, assess treatment plans, and collaborate with healthcare providers to optimize resource utilization. This role requires strong clinical knowledge, analytical skills, and a commitment to delivering cost-effective care.
Key Responsibilities
- Review patient medical records to assess the appropriateness of services.
- Apply established criteria and guidelines to determine medical necessity.
- Collaborate with physicians and other healthcare providers.
- Identify opportunities to improve resource utilization.
- Maintain accurate documentation of review findings.
Required Skills
- Valid RN license.
- Experience in utilization review or case management.
- Strong analytical and critical thinking skills.
- Knowledge of healthcare regulations and guidelines.