Utilization Review RN
About The Position
The Utilization Review RN is a utilization management professional responsible for supporting healthcare efficiency and quality through sound clinical decision-making, regulatory compliance, and responsible use of resources. The role reviews medical records, authorizes services, and prepares cases for physician review in partnership with utilization management teams. It monitors patient care for appropriateness, quality, and cost-effectiveness, applying established criteria. Success requires a strong clinical background, utilization management and regulatory knowledge, analytical and organizational skills, precise chart management, and effective, empathetic communication.
Requirements
- At least two years of acute hospital clinical experience, or a master's degree in Case Management or a Nursing field in lieu of one year of experience.
- RN license in the state or states covered.
- BLS certification within three months of hiring.
Nice To Haves
- Graduation from an accredited school of nursing with a Bachelor of Science in Nursing (BSN), or a related healthcare field.
- At least five years of nursing experience.
- Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM certification.
Responsibilities
- Review medical records.
- Authorize services.
- Prepare cases for physician review in partnership with utilization management teams.
- Monitor patient care for appropriateness, quality, and cost-effectiveness.
- Apply established criteria to utilization management decisions.
- Manage charts and communicate effectively to support patient care and operational flow.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
