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Clinical Utilization Review Nurse
2 months ago
We are seeking a skilled Utilization Review Nurse to join our team at Children's Healthcare of Atlanta. As a key member of our multidisciplinary team, you will play a critical role in ensuring the efficient and effective use of healthcare resources.
Key Responsibilities- Participate in pre-screening assessments of prospective patients to ensure appropriate clinical review and utilization management.
- Oversee Clinical Review Specialists and maintain necessary documentation and communication with internal and external customers.
- Collaborate with Case Management to facilitate patients moving to appropriate levels of care and notify when patients no longer meet medical necessity.
- Meet productivity and quality assurance standards, demonstrating utilization review proficiency through successful completion of McKesson Interrater Reliability testing.
- 3 years of RN experience in a healthcare setting.
- Bachelor of Science in Nursing or equivalent.
- Previous experience in extensive case management and hospital or insurance-related utilization review preferred.
As a Utilization Review Nurse at Children's Healthcare of Atlanta, you will have the opportunity to work in a dynamic and supportive environment, with a focus on delivering high-quality patient care and promoting efficient healthcare utilization. We offer competitive compensation and benefits, as well as opportunities for professional growth and development.
Children's Healthcare of Atlanta is an equal opportunity employer committed to providing equal employment opportunities to all qualified applicants and employees without regard to race, color, sex, religion, national origin, citizenship, age, veteran status, disability, or any other characteristic covered by applicable law.
