Utilization Review RN

Reviews and coordinates utilization activities related to prospective, concurrent and retrospective activities. Monitors documentation for accuracy and clinical compliance. Performs medical necessity reviews and educates providers and members to promote self-care and self-advocacy.

Requirements

• Graduate from an accredited School of Nursing. Bachelor’s Degree in Nursing, preferred.
• Minimum of five (5) years clinical experience, required.
• Previous experience in case management, disease management, quality management or patient education, preferred.