Utilization Review Nurse

Nurse Reviewer -Utilization Management / Prior Authorization3-6 Month Contract / Temp to PermCompact License RequiredDetermine medical appropriateness of services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination.Perform utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines.Determine medical necessity of each request by utilizing approved evidenced based guidelines / criteriaUtilize decision-making and critical-thinking skills in the review and determination of coverageReviews, documents, and communicates all utilization review activities and outcomesRefers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines