California Licensed Utilization Review RN

Job Summary

A company is looking for a Utilization Review Author to assist hospital clients with case reviews.

Key Responsibilities

• Perform initial admission and continued stay reviews using InterQual or Milliman to determine appropriate levels of care
• Abstract data from medical records to ensure accurate clinical information
• Adhere to quality, timeliness, and productivity standards for nursing utilization review

Required Qualifications

• Active Registered Nurse (RN) license in the state of residence
• Eligibility to obtain a California RN license
• Experience in a clinical inpatient environment
• Hospital-based utilization or case management experience
• Proficiency in basic computer skills