About the Position
Specialty: RN – Utilization Review
Experience: 2+ years of experience in utilization review, case management, or acute care nursing
License: Active State or Compact RN License
Certifications: BLS – AHA; Certified Case Manager (CCM) preferred
Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning
Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs.
Requirements
Required for Onboarding:
| Location | East Elmhurst, NY |
| Salary | $2,926.40 |
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