Evaluating clinical requests to determine medical appropriateness, the full-time Washington Licensed Utilization Review Nurse will conduct medical necessity reviews, consult with Medical Directors, and collaborate with various teams while working remotely. Key responsibilities Conduct medical necessity reviews for inpatient admissions, outpatient services, and prior authorizations to ensure alignment with clinical criteria and policies Consult with Medical Directors regarding care that does not meet clinical criteria or medical policies Document clinical information accurately and maintain compliance with accreditation and regulatory requirements Required qualifications Bachelor's degree or four years of relevant work experience Current state licensure as a Registered Nurse Three years of clinical experience Utilization Review experience (preferred) Experience in the health plan industry (preferred)
Washington Licensed Utilization Review Nurse in workfromhome at Unknown Company
This position is listed as full time and able to be worked remotely.