New Hampshire Licensed RN Utilization Review

To support high-quality medical outcomes, the part-time remote New Hampshire Licensed RN Utilization Review will perform concurrent reviews of outpatient and inpatient claims, conduct authorization reviews for patient services, and maintain effective relationships with providers while working 32 hours per week. Key responsibilities Assess, review, and assign cases for utilization review (UR) Negotiate access to care and reimbursement rates with providers and third-party payers Ensure compliance with regulatory changes affecting utilization management and maintain the confidentiality of healthcare information Required qualifications Bachelor's degree in Nursing (RN) required Active New Hampshire RN license Minimum of 2 years of Utilization Review experience Broad knowledge of various insurances and government reimbursements Familiarity with the utilization review process preferred