RN Utilization Review Specialist
Health Business Solutions LLC
Health Business Solutions LLC seeks an experienced Utilization Review Nurse in New York to provide clinical guidance, drive appropriate level of care, and support revenue cycle efficiency. You will conduct medical record assessments, coordinate care with interdisciplinary teams, apply utilization criteria, and collaborate with insurers on denials. Requires RN license (US multi-state/compact), BSN preferred, 2+ years UR experience; CCM a plus; strong analytical and communication skills. #J-18808-Ljbffr Health Business Solutions LLC
Vacancy posted 5 days ago
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