Utilization Review Nurse

FIND YOUR FUTURE

We’re excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and commitment to diversity and inclusion.

Overview

The Utilization Review Nurse (URN) performs clinical review to determine the medical necessity of requested services. The URN obtains clinical information and utilizes Independent Health policy and/or applicable clinical criteria to determine medical necessity, and when necessary, will consult with the Associate Medical Director and/or Medical Director for all requests that do not meet criteria or Independent Health policy. The URN will adhere to regulatory and compliance requirements, department productivity and quality metrics and provide exceptional customer service to all internal and external customers.

Qualifications

Associates Degree in Nursing required; Bachelor’s degree preferred. Current, active, unrestricted, and licensed registered nurse (RN) required.

Two (2) years of clinical experience as an RN in a varied clinical setting required.

Previous utilization review experience preferred.

Previous experience in a managed care setting preferred.

Experience following established medical guidelines required.

Clinical knowledge of the health or social work needs for the population served.

Demonstrated ability to identify barriers to a successful care management path.

Ability to interact effectively and professionally with internal and external customers.

Proficient PC Navigational skills required; solid data entry and MS Office skills required.

Excellent critical thinking and time management skills.

Excellent written, verbal, and interpersonal communication skills, with demonstrated ability to provide exceptional customer service to internal and external customers.

Demonstrated transferable knowledge, skill, and ability to complete job duties independently and proficiently. Flexibility in work schedules and assignments required.

Proven examples of displaying the IH values: Passionate, Caring, Respectful, Trustworthy, Collaborative and Accountable.