RN Utilization Review

Overview:

Utilization management is the analysis of the medical necessity, acute care appropriateness, and efficiency of medical services and procedures in the hospital setting. Utilization review is the assessment for medical necessity, both for admission to the hospital as well as continued stay. This function ensures that services are not only appropriate, but ensures that an authorization for services is obtained from payer, if required, and that documentation supports the care delivered in such a way that minimizes the risk of denials after discharge.

Qualifications:

Required Education: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred Education: Bachelors Science Nursing or higher

Required Experience:2 years previous nursing experience

Preferred Experience: Utilization Review or Case Management experience

Required License/Registration/Certification: Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN) or Licensed Registered Nurse

Preferred License/Registration/Certification:ACM or CCM Certification

Computer Skills Required: Data entry skills; Demonstrable skills with Google Docs, Google Sheets, Microsoft Suite and email applications.