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Utilization Management Nurse Reviewer

Posted 2 months agoViewed

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💎 Seniority level: Junior, Minimum 2 years clinical nursing experience, 1 year in Utilization Management

📍 Location: United States

💸 Salary: 45000 - 70000 USD per year

🔍 Industry: Healthcare, Insurance

🏢 Company: Dane Street, LLC

🗣️ Languages: English

⏳ Experience: Minimum 2 years clinical nursing experience, 1 year in Utilization Management

🪄 Skills: LeadershipMicrosoft AccessCross-functional Team LeadershipCommunication SkillsAnalytical SkillsCollaborationMicrosoft ExcelProblem SolvingOrganizational skills

Requirements:
  • Proficient in written and spoken communication.
  • Ability to maintain professional communication with physicians and clients.
  • Skilled in handling multiple tasks and adapting in a dynamic setting.
  • Strong organizational skills and attention to detail.
  • Adept at solving complex problems.
  • Experienced with Microsoft tools like Word, Excel, PowerPoint, and Outlook.
  • Background in medical or clinical practice through education or professional experience.
  • Holds an unrestricted LVN/RN license from an accredited program.
Responsibilities:
  • Conduct assessments of medical services to validate their appropriateness using established criteria.
  • Examine patient records to verify the quality of care and necessity of services.
  • Provide clinical expertise and reference support for non-clinical staff.
  • Manage clinical details within medical management platforms.
  • Stay updated on regulatory prerequisites for utilization review.
  • Apply clinical reasoning to evidence-based guidelines.
  • Communicate with management, physicians, and the Medical Director to foster patient care.
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