Utilization Review Nurse: Drive Care Quality & Outcomes

TurningPoint Healthcare Solutions LLC; United States; Remote; USD 70,000 - 100,000; Full time

Job summary

TurningPoint Healthcare Solutions LLC is seeking a dedicated Utilization Review Nurse to perform first level clinical reviews using established medical criteria to determine necessity for procedures. The role emphasizes independent work, timely deadlines and attention to detail.

Ideal candidates have RN or LPN licensure, strong nursing theory knowledge, excellent communication and computer skills, and prior utilization management experience.

Qualifications

• RN or LPN license required.
• Strong nursing theory knowledge.
• Excellent customer service and phone etiquette.
• Proficient computer skills, typing, and navigating programs.
• Utilization Management experience preferred.
• Knowledge of musculoskeletal, cardiac, pain management or wound care is a plus.
• Ability to multi-task and work independently in a fast-paced environment.
• Ability to work collaboratively as part of a team.

Responsibilities

• Perform initial clinical reviews and provide documented recommendations based on clinical guidelines.
• Review evaluations against clinical standards and state regulations.
• Assist clinical staff in quality improvements and provide feedback to clients and providers.
• Resolve patient care issues by coordinating with community providers.
• Provide information by responding to physician queries and preparing determinations.
• Improve quality by evaluating procedures and recommending changes.
• Adhere to accreditation and licensing standards and local requirements.

Skills

Nursing knowledge

Customer service

Phone etiquette

Computer skills

Teamwork

Education

RN or LPN license

Tools

EMR software

Job description

TurningPoint Healthcare Solutions LLC is seeking a dedicated Utilization Review Nurse to perform first level clinical reviews using established medical criteria to determine necessity for procedures. The role emphasizes independent work, timely deadlines and attention to detail.

Ideal candidates have RN or LPN licensure, strong nursing theory knowledge, excellent communication and computer skills, and prior utilization management experience.