RN - Utilization Review

RN - Utilization ReviewAbout the PositionSpecialty: RN – Utilization ReviewExperience: 2+ years of experience in utilization review, case management, or acute care nursingLicense: Active State or Compact RN LicenseCertifications: BLS – AHA; Certified Case Manager (CCM) preferredMust-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planningDescription: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs.RequirementsActive RN LicenseBLSClient DetailsCity: East ElmhurstState: NYZip Code: 11369