Utilization Review NurseThe Utilization Review Nurse will evaluate medical records to determine medical necessity by applying clinical acumen and the appropriate application of policies and guidelines to urgent and standard reviews. You will document decisions using indicated protocol sets, or clinical guidelines and provide support and review of medical claims and utilization practices. Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings.Minimum Education Requirement:Minimum of three years of utilization management experience.
Experience in quality-related job preferred. Computer proficiency is required. Excellent customer service skills required.Minimum License Requirement:California RN license.Pay Range:$52.03 - $80.64
RN - Quality Assurance/Utilization Review - Business Development - Full Time 8hr in covina at Unknown Company
- Typical pay
- $71,760–$110,650
For context, most registered nurses earn between $71,760–$110,650 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as full time and onsite.