Utilization Review Clinician - RN - Remote

Overview

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity and coordinating care with healthcare providers.

In Short

• Conduct prior authorization reviews for post-acute care services.
• Approve services in compliance with health plan guidelines.
• Collaborate with case managers and physicians for seamless care transitions.
• Participate in team meetings and educational activities.
• Ensure compliance with federal and state standards.
• Utilize clinical guidelines for benefit determinations.
• Coordinate benefits and transitions between care areas.
• Perform other job duties as assigned.

Requirements

• Bachelor's Degree or equivalent work experience.
• 4-6 years of clinical nursing or therapy experience.
• Active RN license.
• 1-2 years' experience in utilization review or case management preferred.
• Experience with clinical decision support tools.

Benefits

• Excellent medical, dental, and vision benefits.
• Mental health benefits through TelaDoc.
• Generous paid time off and holidays.
• Paid parental leave.
• Educational assistance up to $2500 per year.