New York RN Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse.

Key Responsibilities

• Perform prior authorization, concurrent, and retrospective reviews
• Utilize clinical documentation to determine qualifying health care costs and record review determinations
• Communicate with providers and members, and identify cases that do not meet established criteria

Required Qualifications

• Graduated from an accredited School of Nursing; Associate Degree required, Bachelor's preferred
• Minimum of 2 years of direct clinical nursing experience
• Minimum of 2 years of experience in medical management activities in a managed care environment
• RN license required