Rising Medical Solutions
Healthcare
UtilizationReviewNurse
“Utilization Review Nurse at Rising Medical Solutions. Skills: Utilization Review, Clinical Practice, Case Management, Documentation. Perform utilization review process. Review records and requests for UR”
Industry & Context.
Critical thinking
What They're Looking For.
Must Have
Associate's or Bachelor's degree in Nursing, Active and unencumbered RN license, 3 to 5 years clinical practice experience, 2 years case management or UR experience, Proficient in computer use, Proficient in Microsoft Word, Proficient in Microsoft Excel, Proficient in Microsoft Outlook
Nice to Have
More than one state license
What You'll Do.
Perform utilization review process
Review records and requests for UR
Use evidence-based guidelines
Determine authorization
Send file for Peer or Physician Review
Write nurse summaries on UR files
Document properly in databases
Send determination letters
Establish collaborative relationships
Track ongoing status of UR activity
Meet appropriate turn-around times
Maintain organized files
Respond to written and telephonic inquiries
How You'll Work.
Team & Collaboration
Collaborative relationships with clients; Collaborative relationships with patients; Collaborative relationships with employers; Collaborative relationships with providers; Collaborative relationships with attorneys
Communication Scope
Oral communication; Written communication
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