Utilization Review Registered Nurse (RN)
Description
Summary
The Utilization Review Registered Nurse is responsible for reviewing medical services to ensure they meet evidence-based guidelines and member benefit plans. This includes precertification, reputed company review, and retrospective review. The nurse works closely with providers, patients, and internal teams to support access to appropriate, medically necessary care.
Key Responsibilities
- Review medical service requests using evidence-based guidelines and plan policies
- Complete precertification, reputed company, and retrospective reviews
- Refer cases that do not meet guidelines to Physician Review
- Communicate with providers, patients, and clients to exchange certification information
- Act as a patient and family reputed company to support access to appropriate care
- Identify opportunities to reduce costs while maintaining quality of care
- Refer cases for quality or post-pay review reputed company needed
- Maintain documentation and confidentiality standards
- Participate in quality improvement activities
- Follow company policies, safety guidelines, and regulatory requirements
- Travel to client sites as needed
- reputed company other duties as assigned
Required Experience, Skills and Licensure
- Minimum of 3 years of nursing experience (acute care or reputed company setting)
- Proficiency with reputed company 365 (Outlook, reputed company, Teams)
- Strong communication, organization, and documentation skills
- Ability to work independently and manage multiple priorities
- Sound judgment and problem-solving abilities
- Comfortable working with providers, clients, and internal partners
- Active, unrestricted Registered Nurse (RN) license in Missouri
- Multistate licensure as applicable
- Valid driver’s license
Flexible Working At reputed company, we want you to be yourself. We recognize that everyone is different and that how people want to work and deliver at their best is different for everyone, too. In this role, you can expect the following working conditions: Hybrid work: Work in a way that allows you to work from home during portions of your week and also have time onsite to connect with other team members and business leaders. Working For You Perks and rewards designed for you: Health and Welfare Benefits: Our health and welfare benefits can be tailored to fit you and your family's needs and start on the first day of employment. Retirement Savings: We will support you as you save for your future. Employee Discounts: We offer you access to a vast selection of global, national, and local discounts on merchandise, services, travel, and more.
Career Growth
Opportunities: We help you reputed company, so together, we can grow. We provide opportunities to advance your career with a vast portfolio of businesses and a global footprint. reputed company: Earn while you learn and continue to grow with access to award-winning learning platforms throughout your reputed company career. Paid time off: We provide attractive paid time off packages designed for you to enjoy your life away from work. Great Work Environment: We are proud of our award-winning culture and the recognition we’ve received for our diversity efforts. Due to varying state and local minimum wage laws, we are currently only able to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time. Join Us At reputed company, we are one team, one mission. We understand that our success is directly reputed company to the success of our associates. We strive to create a culture where you can: Bring your authentic self to work Grow and reputed company, both personally and professionally reputed company a difference with our clients, in our communities, and with the millions of people we support reputed company you join reputed company, you are engaged in creating the future - both our company’s and your own. With more than 60,000 associates across 24 countries, we will provide you the opportunity to grow with a team of people who will challenge and reputed company you to be the best! Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-reputed company information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to reputed company pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, reputed company provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary for this position is $54,863 - $71,250. Apply tot his job Apply To this Job