Utilization Management Nurse Reviewer (Weekend Shift)

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Requirements:

• Holds an unrestricted LVN/RN license from an accredited program.
• Minimum 2 years of clinical nursing experience.
• 1 year of experience in Utilization Management.
• Proficient in written and spoken communication.
• Skilled in Microsoft tools (Word, Excel, PowerPoint, Outlook).
• Organizational skills and attention to detail.

Responsibilities:

• Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines.
• Examine and evaluate patient records for quality of care and necessity of services.
• Offer clinical expertise to non-clinical staff.
• Manage clinical details within medical management platforms.
• Stay updated with regulatory requirements and state standards.
• Communicate with management teams, physicians, and Medical Director to foster patient care.