To support patient care initiatives, the full-time Georgia Licensed Utilization Review Nurse will conduct thorough medical necessity reviews and collaborate with healthcare teams while working remotely. Key responsibilities Conduct comprehensive medical necessity reviews using InterQual Criteria and ensure compliance with regulatory requirements Communicate effectively with provider teams regarding patient class designations and medical necessity determinations Document and manage utilization reviews, including identifying avoidable delays and following denial workflows Required qualifications Associate degree in nursing Minimum of 5 years of recent acute hospital experience or 2 years of utilization review experience Valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board Ability to meet quality and productivity expectations and complete yearly competencies Experience with InterQual Level of Care Criteria is preferred
Georgia Licensed Utilization Review Nurse in workfromhome at Unknown Company
This position is listed as contract and able to be worked remotely.