Utilization Review Nurse

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Job Description

Job title: Utilization Review Nurse, RN

 

We’re currently seeking an Utilization Review Nurse, RN to join the Population Health Division.  This person will be responsible for assuring high quality, cost efficient medical outcomes for patients needing inpatient and/or outpatient preauthorization by reviewing records for medical necessity, level of care, length of stay, experimental/investigational treatment and appropriate billing/coding. Responsible for screening for Case Management and Disease Management. Provide patients with healthcare information regarding Medicare, Medicaid Assist or private healthcare coverage.

Assist in maintaining accurate records as well as preparation of reports.

Requirements:

  • Minimum 2 years nursing experience required. Knowledge of ICD-9/10, CPT and HCPC coding a plus.
  • Ability to navigate a Windows based environment and create, edit, save and send documents utilizing Microsoft Word & Excel. Ability to navigate Outlook and conduct Internet searches.
  • Proficiency with navigating multiple computer programs simultaneously while talking on the phone.
  • Ability to work independently toward established priorities and goals
  • Previous experience in a telephonic role is a plus
  • Bilingual fluency with English and Spanish is a plus

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