Job Description

Registered Nurse (RN) - Utilization Review

Job Summary: The RN Utilization Review evaluates the medical necessity, efficiency, and appropriateness of patient admissions and treatments. This role involves reviewing clinical records, coordinating with insurance providers, and ensuring compliance with regulations.

Key Responsibilities:

• Analyze patient records and treatment plans to confirm medical necessity and coverage.
• Collaborate with physicians and insurance companies to optimize length of stay.
• Facilitate discharge planning and resource allocation for patients.
• Document and track utilization metrics, identifying areas for improvement.
• Educate clinical staff on documentation requirements and best practices.

Work Environment:

• Hospital utilization review departments or insurance organizations.
• Requires knowledge of reimbursement policies, clinical guidelines, and regulatory standards.

Benefits:

• Competitive salary and benefits.
• Opportunities for influencing cost-effective, high-quality patient care.
• Collaborative interactions with healthcare providers and payers.
• Potential for remote or office-based work, depending on the organization.

Why Choose Us:

We strive for a balance between quality patient care and responsible resource use. Join our utilization review team to help shape efficient, patient-focused healthcare delivery.

Information based on the BLS and actual job responsibilities may vary by location.

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