Utilization Review Nurse — Elevate Patient Care & Collaboration

Ethos Risk Services; Broussard (LA); On-site; USD 85,000 - 110,000; Full time

Job summary

Ethos Risk Services, based in Broussard, LA, is seeking a full-time Utilization Review Nurse to coordinate and manage all aspects of the utilization review process. The role ensures medical necessity and promotes optimal patient outcomes through initial clinical reviews and appropriate certifications.

The candidate will guide non-clinical staff, maintain URAC-compliant documentation, and collaborate with providers to deliver cost-effective, high-quality care.

Qualifications

• Associate degree or higher in a healthcare field is required.
• RN license or LVN/LPN certification is required.
• CCM/HCQM or similar certification preferred.
• Minimum of 2 years of clinical nursing experience.
• Experience in utilization review, medical management, or workers' compensation preferred.

Responsibilities

• Conduct timely utilization reviews for medical necessity and appropriateness.
• Evaluate ongoing treatment needs and discuss options with providers.
• Prepare case summaries and document in URAC-compliant systems.
• Coordinate with peer reviewers during peer review processes.
• Partner with providers to ensure cost-effective, quality patient care.
• Provide guidance to non-clinical staff within the UM team.
• Support Quality Management objectives and maintain confidentiality.
• Uphold regulatory and ethical standards.

Skills

Verbal and written communication

Multitasking

Team collaboration

Confidentiality

Education

Associate degree or higher in healthcare

Tools

Microsoft Office Suite

Electronic documentation systems

Job description

Ethos Risk Services, based in Broussard, LA, is seeking a full-time Utilization Review Nurse to coordinate and manage all aspects of the utilization review process. The role ensures medical necessity and promotes optimal patient outcomes through initial clinical reviews and appropriate certifications.

The candidate will guide non-clinical staff, maintain URAC-compliant documentation, and collaborate with providers to deliver cost-effective, high-quality care.