DC Licensed Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN (Remote) for their Utilization Management department.

Key Responsibilities

• Conduct clinical chart reviews and apply clinical criteria according to protocols and payer agreements
• Review admission service requests for medical necessity and compliance with reimbursement policies
• Serve as a resource for education and communication regarding utilization review and performance improvement

Required Qualifications

• 3-5 years of experience in acute care case management or utilization management activities
• Knowledge of InterQual/Milliman criteria and CMS guidelines
• Current certification in Utilization Management/Case Management
• RN-BSN preferred; RN-AA acceptable
• DC or MD nursing license required as per state policy