Job Description
Nurse Reviewer -Utilization Management / Prior Authorization
3-6+ Month Contract / Temp to Perm
Compact License Required
- Determine 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 / criteria
- Utilize decision-making and critical-thinking skills in the review and determination of coverage
- Reviews, documents, and communicates all utilization review activities and outcomes
- Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines
Job Tags
Permanent employment, Contract work, Temporary work,