Utilization Review Nurse RN

Seeking a part-time Utilization Review Nurse RN, the candidate will perform medical-necessity reviews and level-of-care determinations, ensuring compliance with established guidelines while working up to 28 hours per week, including weekends. Key responsibilities Conduct utilization management reviews and apply medical policies and evidence-based criteria for service requests Analyze clinical documentation for completeness and escalate cases to the Medical Director as needed Document reviews and outcomes accurately in designated systems to support quality oversight and compliance Required qualifications Current, unrestricted RN license in the United States or U.S. territory Graduate of an accredited nursing program (ADN or diploma required; BSN preferred) Minimum 1-2 years of recent clinical experience in relevant settings Prior utilization review or management experience preferred Ability to interpret medical records and apply evidence-based criteria effectively