Job Details
Registered Nurse (RN) – Utilization Review
We are seeking an experienced Registered Nurse (RN) – Utilization Review to review patient care and clinical documentation to ensure appropriate, cost-effective, and medically necessary utilization of healthcare services.
Key Responsibilities:
- Review medical records for medical necessity and appropriate level of care.
- Evaluate admissions, continued stays, and treatment plans.
- Apply clinical guidelines and payer criteria to utilization decisions.
- Collaborate with physicians, case managers, and insurance providers.
- Identify gaps in care and support appropriate resource utilization.
- Maintain accurate documentation and utilization review records.
Qualifications:
- Graduate of an accredited Nursing program.
- Active RN license as required by state regulations.
- Previous Utilization Review, Case Management, or acute care experience preferred.
- Strong knowledge of medical necessity criteria and clinical guidelines.
- Excellent clinical assessment, analytical, and communication skills.
Pay Rate
$48.65 - $53.53/hour
About us :
At MedCadre , we’re dedicated collaborators, bridging the gap between top-tier professionals and healthcare organizations that prioritize excellence. By fostering transparent communication and leveraging deep industry expertise, we build enduring partnerships rooted in trust.
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