Utilization Review Nurse - RN Case Management

Integrated Resources Inc.; North Charleston (SC); On-site; USD 70,000 - 80,000; Full time

Job summary

A leading healthcare organization is seeking a Utilization Management Nurse to oversee reviews of service requests and ensure clinical criteria are met. The ideal candidate will have extensive experience in managed care quality assurance, demonstrating strong clinical judgement and communication skills. This role involves coordinating with healthcare providers to facilitate patient care and support service delivery standards.

Qualifications

• Two years of experience in managed care quality assurance or utilization review.
• RN must have two years of experience in an acute care hospital.

Responsibilities

• Conduct reviews for medical necessity criteria and perform concurrent reviews.
• Communicate with providers to coordinate services and discharge planning.
• Create and maintain reports on inpatient activities.

Skills

Clinical evaluation

Interpersonal communication

Problem solving

Job description

A leading healthcare organization is seeking a Utilization Management Nurse to oversee reviews of service requests and ensure clinical criteria are met. The ideal candidate will have extensive experience in managed care quality assurance, demonstrating strong clinical judgement and communication skills. This role involves coordinating with healthcare providers to facilitate patient care and support service delivery standards.