New Hampshire Licensed RN Utilization Reviewer

To support patient care initiatives, the part-time per diem New Hampshire Licensed RN Utilization Reviewer will perform concurrent reviews of outpatient and inpatient claims, manage authorization reviews, and facilitate communication among treatment teams in a remote setting. Key responsibilities Conduct concurrent reviews of patient claims and authorization requests to ensure high-quality medical outcomes Maintain relationships with healthcare providers and assist in negotiating access to care and reimbursement rates Prepare clinical information from medical records for utilization review processes Required qualifications Associate's degree in Nursing required; BSN preferred Current Registered Nurse (RN) license in New Hampshire 2-3 years of clinical experience, including experience with rehabilitation and psychiatric inpatient populations Minimum of 2 years of experience in utilization review Broad knowledge of various insurances and government reimbursement processes