Registered Nurse (RN) - Utilization Review - Remote

Overview

The Utilization Review RN is responsible for utilization management and utilization review for prospective, concurrent, or retrospective review, functioning as part of a multidisciplinary team.

In Short

• Responsible for utilization management and review.
• Works with a multidisciplinary team including physicians and social workers.
• Conducts reviews of inpatient and outpatient services.
• Determines medical appropriateness of services based on guidelines.
• Requires RN licensure in Virginia.
• Minimum of three years nursing experience required.
• Proficient in Milliman Care Guidelines or InterQual criteria.
• Responsible for patient safety initiatives.
• Ability to adapt to a fast-paced environment.
• Position is remote.

Requirements

• Bachelor's in Nursing from an accredited program.
• Current RN licensure in Virginia.
• 15 Continuing Education Units per year required.
• Preferred: Master's Degree in Nursing or related field.
• Preferred: Case Management Certification.
• Experience in Utilization Review or Management preferred.
• Strong problem-solving and reasoning skills.
• Ability to handle multiple priorities.
• Experience in a healthcare setting.
• Effective communication skills.

Benefits

• Opportunity to work in a leading healthcare system.
• Collaboration with top-notch medical teams.
• Engagement in patient safety initiatives.
• Support for professional development.
• Flexible work schedule.
• Remote work opportunity.