Ohio Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse RN or LVN.

Key Responsibilities

• Perform concurrent review and prior authorization assessments per company policy
• Evaluate member eligibility, benefits, and appropriate level of care
• Participate in interdepartmental collaboration and consult with medical directors as needed

Required Qualifications

• Completion of an accredited Registered Nursing or Vocational Nursing program
• Minimum 2 years of utilization management or case management experience in a managed care organization
• Active, unrestricted RN or LVN license in Ohio or a compact state
• Familiarity with InterQual criteria and UM software
• Proficiency in Microsoft Office (Word, Excel, Outlook)