Utilization Review Registered Nurse
$52.03 - $80.64 per hourEmanate Health
Utilization Review NurseThe Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.Minimum Education RequirementCalifornia RN license.Minimum Experience RequirementMinimum of three years of utilization management experience. Experience in quality-related job preferred. Computer proficiency is required. Excellent customer service skills required.Pay Range:$52.03 - $80.64
Vacancy posted 2 days ago
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