Utilization Management Nurse Reviewer

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.

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.