Utilization Review Nurse

Key Responsibilities:

• Review medical records to develop concise clinical reviews for authorization and reimbursement.
• Facilitate communication with payors to ensure medical necessity and prevent denials.
• Collaborate with interdisciplinary team to optimize patient care and manage concurrent denials.

Qualifications:

• Current Registered Nurse license and three years of healthcare clinical experience.
• Bachelor's degree in Nursing preferred or enrollment in BSN program.
• Knowledge of medical terminology and third-party payers required.

Work Environment:

• Remote home office with occasional weekend and holiday shifts.
• Fast-paced, rapidly changing regulatory environment.
• Requires strong attention to detail and effective communication skills.