Offering a flexible PRN opportunity, the Utilization Review Nurse will conduct assessments of medical services, review patient records, and collaborate with healthcare providers to ensure the appropriateness and necessity of treatments while working remotely. Key responsibilities Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services Provide clinical expertise and serve as a reference for non-clinical staff members Required qualifications Licensed Practical/Vocational Nurse with an active and unrestricted license or a nursing degree from an accredited college Minimum of 2 years of clinical nursing experience, including at least 1 year in Utilization Management Proficient in Microsoft tools such as Word, Excel, PowerPoint, and Outlook Strong understanding of medical necessity criteria and utilization review regulations Ability to maintain professional communication with healthcare providers and clients