Inpatient Utilization Review Nurse - Care & Compliance

Integrated Resources Inc.; Columbus (OH); On-site; USD 55,000 - 75,000; Full time

Job summary

A leading company in healthcare services is seeking a Care Review Clinician for their Medicaid Division. The candidate will play a crucial role in inpatient medical necessity reviews, ensuring the best outcomes for members while adhering to regulatory guidelines. Ideal individuals must have relevant Utilization Review experience and a strong clinical assessment background.

Qualifications

• 1+ year of Utilization Review experience or 3-4 years of recent hospital experience.
• Experience with MCG guidelines is a plus.
• Nurses with production and review work experience are welcomed.

Responsibilities

• Review inpatient cases for medical necessity and authorization.
• Conduct concurrent reviews based on clinical information provided.

Skills

Hospital Utilization Management

Utilization Review

Clinical Evaluation

Job description

A leading company in healthcare services is seeking a Care Review Clinician for their Medicaid Division. The candidate will play a crucial role in inpatient medical necessity reviews, ensuring the best outcomes for members while adhering to regulatory guidelines. Ideal individuals must have relevant Utilization Review experience and a strong clinical assessment background.