Utilization Management Nurse Reviewer

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Requirements:

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks and adjusting in a dynamic office setting.
• Possesses a keen organizational sense and pays attention to details.
• Adept at resolving intricate problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Holds an unrestricted LVN/RN license from an accredited vocational nursing program or nursing degree from an accredited college.
• Minimum 2 years clinical nursing experience and 1 year of Utilization Management experience.

Responsibilities:

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines.
• Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services.
• Offer clinical expertise to non-clinical staff members.
• Manage essential clinical details within various medical management platforms.
• Foster efficient patient care by effectively communicating with management, physicians, and others.