Utilization Review RN

Job Title: Utilization Review RN

Are you an experienced Registered Nurse with Utilization Review experience professional looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Position Summary:

As the Utilization Review RN, you would be responsible for telephonically reviewing medical information in order to determine medical necessity of continued stay according to review standards.

Hours for this Position: Monday-Friday 8:00am-5:00pm

Advantages of this Opportunity:

• Competitive salary, negotiable based on experience
• Benefits offered, Medical, Dental, and Vision
• Fun and positive work environment
• Weekly deposit options

More Insight of Daily Responsibilities:

• Ensures that services provided to eligible members are within benefit plan and appropriate contracted providers are being utilized
• Determines medical necessity and length of stay based on the consistent application of CMS criteria
• Assesses and coordinates simple discharge planning
• Identifies quality of care issues

What We Look For:

• RN license in the state of TN
• Bachelor's Degree in related field
• 2+ years of experience in UM, UR, pre-authorization, concurrent review, discharge planning and/or skilled nursing