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Utilization Review RN (remote)
JOB SUMMARYThe Utilization Review Registered Nurse (RN) provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient services. Provides feedback and assistance to other members of the healthcare team regarding the appropriate use of resources and timely follow-through with the plan of care. Provides ongoing communication with the health plan, provider utilization and/or care coordination departments regarding medical necessity for prospective, concurrent, and retrospective reviews. Collaborates as a team to ensure that medical records support the level of services being delivered.ESSENTIAL FUNCTIONS OF THE ROLE


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