Nurse Reviewer -Utilization Management
3-6 Month Contract / Temp to Perm
** Candidates Must have active Rhode Island Nursing License**

• Conduct pre and post payment review of inpatient admissions, outpatient services, and other procedures to assess the medical necessity and appropriateness of services on-site or in-house.
• Discuss cases with attending physician and other health care professionals.
• Prepare and refer concerns to plan Medical Directors.
• Medical reviews, including pre-authorization, concurrent review, screening for quality-of-care issues, and discharge planning.
• Document rationale for medical decisions made.
• Monitor and evaluate patient’s plan of care and identify potential issues, recommend appropriate interventions if needed.

Suggested Experience / Requirements

• Unrestricted Rhode Island Nursing License
• 3 years of acute medical or clinical experience or experience in utilization reviews
• Understanding of utilization review techniques including all aspects of the medical review function, including pre-authorization, concurrent review and discharge planning
• Advanced analytical skills, with the ability to interpret and synthesize complex data sets
• Excellent verbal and written communications skills, negotiation skills, presentation skills
• Excellent organizational skills and ability to prioritize multiple tasks

EEO Statement. We welcome all applicants and qualified individuals, who will receive consideration for employment without regard to their race, color, religion, national origin, sex, sexual orientation, gender identity, protected veteran status or disability.