Utilization Review Nurse: Impactful Clinical Decisions

TurningPoint Healthcare Solutions; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

TurningPoint Healthcare Solutions is seeking an Utilization Review Nurse to apply clinical guidelines for medical necessity and contribute to a fast-paced environment. You will evaluate documentation, coordinate with providers, and support quality improvement initiatives while maintaining high attention to detail.

The role emphasizes independent work, strong communication with physicians, and adherence to regulatory standards in a healthcare setting.

Qualifications

• Licensed RN or NP required with knowledge of general nursing theory.
• Experience with utilization management preferred but not required.
• Strong customer service and phone etiquette; able to work independently.
• Proficient computer skills and typing; able to navigate multiple programs.
• Detail-oriented, organized, and able to meet deadlines in a fast-paced environment.

Responsibilities

• Perform initial clinical reviews and provide documented recommendations based on clinical guidelines.
• Review the initial evaluation against clinical standards, state regulations and guidelines.
• Assist clinical staff in quality improvement projects within scope of practice.
• Resolve patient care issues by coordinating with community providers and staff.
• Respond to physician queries and prepare information for determinations.
• Improve quality by evaluating procedures and recommending changes when needed.
• Adhere to accreditation, professional standards, and company policies and licensing requirements.

Skills

Nursing service

Customer service

Phone etiquette

Computer skills

Utilization Management experience

Multi-tasking

Teamwork

Education

RN or NP license

Job description

TurningPoint Healthcare Solutions is seeking an Utilization Review Nurse to apply clinical guidelines for medical necessity and contribute to a fast-paced environment. You will evaluate documentation, coordinate with providers, and support quality improvement initiatives while maintaining high attention to detail.

The role emphasizes independent work, strong communication with physicians, and adherence to regulatory standards in a healthcare setting.