Registered Nurse Utilization Review

Performing medical record reviews for severity of illness and intensity of service, the part-time Registered Nurse Utilization Review will liaise with external review agencies to ensure compliance with regulations affecting financial reimbursement while documenting variances from established pathways in a remote setting. Key responsibilities: Collect information from clinical medical records and document severity of illness and intensity of service in the clinical database Monitor levels of care for appropriateness, communicate variances, and evaluate care plans based on accepted standards Provide information to external review organizations and refer patients not meeting criteria to designated physician advisors Required qualifications: Current Registered Nurse (RN) licensure BSN preferred with 2-5 years of previous Utilization Review experience Current CPR certification Experience in hospital nursing, hospital case management, insurance case management, or utilization management preferred Knowledge of clinical norms and effective time management skills