Utilization Review Nurse

Working remotely, the Oregon Licensed RN Reviewer will conduct utilization management reviews to ensure appropriate patient care and resource utilization in a part-time capacity. Key responsibilities Coordinate accurate patient status identification and documentation Ensure correct admission status and reimbursement through certification and clinical review Gather additional clinical documentation to validate treatment plans and level of care Required qualifications Bachelor of Science in Nursing (BSN) 3+ years of acute care hospital experience with strong clinical knowledge In-depth understanding of Medicare/Medicaid UM regulations, RAC, QIO, MAC, and denial/appeals processes Active RN license in your state of residence (WA, OR, or AK)