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

• Conduct assessments of medical services to validate their appropriateness.
• Examine and evaluate patient records for quality of care.
• Offer clinical expertise to non-clinical staff.
• Input and manage clinical details in medical management platforms.
• Stay updated with regulatory prerequisites and state standards.
• Apply clinical reasoning for evidence-based guidelines.
• Communicate effectively with management and healthcare providers.
• Maintain professional communication with clients.
• Handle multiple tasks in a dynamic office setting.
• Possess a keen organizational sense and attention to detail.

Requirements

• Proficient in written and spoken communication.
• Skilled at resolving complex problems.
• Experienced with Microsoft tools.
• Background in medical or clinical practice.
• Holds an unrestricted LVN/RN license.
• 2 years minimum clinical nursing experience.
• 1 year of experience in Utilization Management.
• Strong interpersonal skills.
• Proficient understanding of computer operations.
• Ability to acquire new skills as needed.

Benefits

• Flexible, as-needed staffing.
• Opportunity to work during peak times, weekends, and holidays.
• Maintain QA skills and familiarity with processes.
• Work from home with technical requirements.
• Supportive team environment.