PRN Utilization Review Nurse Reviewer - Remote

Overview

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments.

In Short

• Immediate Hiring
• 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.
• Offer clinical expertise and serve as a clinical reference for non-clinical staff members.
• Input and manage essential clinical details within various medical management platforms.
• Keep up-to-date with regulatory prerequisites and state standards for utilization review.
• Apply clinical reasoning to determine suitable evidence-based guidelines.
• Foster efficient and high-quality patient care through effective communication.
• PRN nurses will be required to work at least one weekend per month.
• A minimum number of shifts per month will be mandated.

Requirements

• Proficient in both written and spoken communication.
• Capable of maintaining professional communication with physicians and clients.
• Skilled at handling multiple tasks in a dynamic office setting.
• Possesses a keen organizational sense and pays close attention to details.
• Adept at resolving intricate problems.
• Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook.
• Background in medical or clinical practice.
• Holds an unrestricted LVN/RN license.

Benefits

• Flexible, as-needed staffing to support the team during peak times.
• Opportunity to maintain QA skills and familiarity with processes.
• Work from home with technical requirements for internet services.