Clinical Utilization Review Nurse - Onsite

Ethos; Broussard (LA); On-site; USD 65,000 - 85,000; Full time

Job summary

Ethos is seeking a full-time Utilization Review Nurse to join our Medical Management Team in Broussard, LA. The role focuses on coordinating and managing utilization review processes, ensuring medical necessity, and issuing certifications when appropriate.

The nurse will provide clinical oversight to non-clinical staff, collaborate with providers, and support URAC standards while maintaining confidentiality and compliance across the program.

Qualifications

• Associate degree or higher in a healthcare field.
• RN license OR LVN/LPN certification required.
• 2+ years of clinical nursing experience required.
• Certification such as CCM/HCQM preferred.
• Experience in utilization review or medical management preferred.
• Excellent verbal and written communication.

Responsibilities

• Conduct timely utilization reviews for medical necessity and appropriateness.
• Evaluate continued or alternative treatment needs and discuss options with providers.
• Prepare clear case summaries and document in the UR system per URAC standards.
• Coordinate with peer reviewers and facilitate peer review discussions.
• Partner with providers to ensure cost-effective, high-quality patient care.
• Provide clinical guidance to non-clinical team members.
• Support Quality Management objectives and maintain confidentiality.
• Maintain compliance with regulatory and ethical standards.

Skills

Verbal communication

Written communication

Microsoft Office

Analytical skills

Organization

Negotiation

Confidentiality

Education

Associate degree or higher in healthcare

Tools

EHR systems

Job description

Ethos is seeking a full-time Utilization Review Nurse to join our Medical Management Team in Broussard, LA. The role focuses on coordinating and managing utilization review processes, ensuring medical necessity, and issuing certifications when appropriate.

The nurse will provide clinical oversight to non-clinical staff, collaborate with providers, and support URAC standards while maintaining confidentiality and compliance across the program.