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,

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