Nurse Utilization Review Specialist
12 hours ago
The Utilization Review Nurse Specialist is responsible for reviewing all admissions, continued stays, and discharges to ensure medical necessity and compliance with established criteria. This role requires strong communication and coordination skills to work with insurance companies, medical staff, and the discharge team.
Key Responsibilities- Review admissions, continued stays, and discharges for medical necessity and compliance with established criteria
- Communicate with insurance companies, medical staff, and the discharge team to ensure appropriateness of admission and/or need for continued stay
- Coordinate the appeal process with physicians and hospital staff for admission, continued stay, or quality denials
- Complete all utilization review documentation according to established guidelines
- Participate in the Utilization Management Committee to educate staff and providers regarding utilization review criteria
- Registered Nurse licensure in North Dakota or a Compact State Agreement
- Minimum 3 years of related experience
- Strong communication and coordination skills
- Ability to work in a fast-paced environment
This position is remote, but the candidate must be local. The work environment is primarily indoor with occasional outdoor activities.
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Clinical Utilization Review Coordinator
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Travel Nurse ICU Specialist
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Travel Nurse ICU Specialist
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Travel Nurse ICU Specialist
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Travel Nurse ICU Specialist
2 weeks ago
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Travel Nurse ICU Specialist
1 week ago
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Precision Agriculture Specialist
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Travel Nurse ICU Specialist
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Nursing Specialist
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