Utilization Review Nurse - 249106

Medix™; Arizona; On-site; USD 85,000 - 110,000; Full time

Job summary

Medix is seeking a qualified registered nurse for utilization review in Arizona. You will perform frequent case reviews, check medical records, and discuss treatment with care providers to ensure appropriate care based on research results.

Required are active RN licensure in the US, either a state license or compact multistate license, plus 1+ year in utilization review within managed care; acute care clinical experience is also expected.

Qualifications

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing.
• MCG or InterQual tooling experience.
• Ability to obtain additional state licenses to meet business needs.
• 1+ year of utilization review experience in a managed care setting.
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital).

Responsibilities

• You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed.
• You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Skills

Active RN licensure (US)

Compact multistate RN license (NLC)

Utilization review experience

Acute care clinical experience

Licensure expansion ability

Education

Associate/Bachelor Nursing degree

Tools

MCG tooling

InterQual tooling

Job description

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Required Skills

• Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing
• MCG or InterQual tooling experience
• Ability to obtain additional state licenses to meet business needs
• 1+ year of utilization review experience in a managed care setting
• 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital)

Preferred Skills

• BSN
• Previous experience conducting concurrent or inpatient reviews for a managed care plan