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Position Overview
The Utilization Review Nurse is responsible for coordinating all components of the utilization review process, which includes timely review of treatment requests for medical necessity, ensuring appropriate cost-effective treatment and promotion of best patient outcomes. The Utilization Review Nurse performs the initial clinical review, prepares an organized case summary and may issue certifications of medical necessity. When clinical requirements for medical necessity, appropriateness or effectiveness are not met and a clinical determination to certify the request cannot be made, the Utilization Review Nurse must escalate the case for peer clinical review. The Utilization Review Nurse provides clinical oversight and serves as a resource for non-clinical staff.
Roles and Responsibilities
Qualifications
Education/Licensure/Certification
Experience
Skills/Knowledge
Ethos Risk Services is an equal opportunity employer that does not discriminate on the basis of religious creed, sex, national origin, race, veteran status, disability, age, marital status, color or sexual orientation or any other characteristic protected by law.
A background check will be conducted, in accordance to the local state law and regulations.
Full Time
$73k-90k (estimate)
04/18/2024
06/15/2024
ethosinvestigations.com
St Petersburg, FL
<25
The job skills required for Utilization Management Nurse include Health Care, Customer Service, Direct Patient Care, Confidentiality, Written Communication, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Management Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Management Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Management Nurse positions, which can be used as a reference in future career path planning. As an Utilization Management Nurse, it can be promoted into senior positions as a Head Nurse - CCU that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Management Nurse. You can explore the career advancement for an Utilization Management Nurse below and select your interested title to get hiring information.