PRN Utilization Review Nurse Reviewer
New
D
Dane StreetHealthcare
United StatesPart-TimeMiddle
Salary not disclosed
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Job Details
- Experience
- 2 yrs minimum clinical nursing experience; 1 year of previous experience in Utilization Management.
- Required Skills
- Microsoft AccessMicrosoft ExcelPowerPoint
Requirements
- Active and unrestricted LVN or RN license from an accredited program.
- Minimum 2 years of clinical nursing experience.
- Minimum 1 year of experience in Utilization Management.
- Proficient in written and spoken communication for professional interactions with physicians and clients.
- Strong organizational skills and attention to detail.
- Proficient in Microsoft Word, Excel, PowerPoint, Outlook, and Access.
- Must be able to maintain an uninterrupted internet connection for remote work.
- Availability to work at least one weekend per month, one major holiday, and one minor holiday per year.
- Capable of multi-tasking and adjusting to a dynamic work setting.
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 and serve as a clinical reference for non-clinical staff members.
- Input and manage essential clinical details within various medical management platforms.
- Keep up-to-date with regulatory prerequisites such as URAC and state standards for utilization review.
- Apply clinical reasoning to determine the suitable evidence-based guidelines.
- Foster efficient and high-quality patient care by communicating with management teams, physicians, and the Medical Director.
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