Utilization Review Nurse

Company: Medix ( Learn More )

General Information
US-TN-Nashville
N/A
Not Specified
Full-Time
Not Specified
Not Specified
False
False
Job Description Are you inspired to pioneer new models of care? Do you want to align yourself with an organization that is changing the healthcare experience for patients?  If you enjoy advanced technology and innovative procedures, we have an exciting opportunity for you to join our team!


We are hiring for a Utilization Review nurse with an elite managed care organization. The Utilization Review nurse will complete inpatient admission and concurrent reviews for medical necessity. They will assist and coordinate the discharge planning needs with the facility staff, attending physician, the member, and their support system.



  • In collaboration with all disciplines, identifies appropriate use of resources
  • Maximizes positive financial outcomes assuring patient charges are accurate through proper documentation
  • Monitors admission and continued stay criteria for all payers and responds to third party payer requests related to claims, denials, appeals, and quality concerns
  • Communicate requests that do not meet criteria with Medical Director


  • Minimum Qualifications:


  • Registered Nurse in the state of _____
  • 5+ years strong clinical skills
  • Utilization Review experience
  • Ability to navigate multiple computer systems and strong typing skills
  • Superior critical thinking & problem solving skills



  • Keywords: case manager, case management, utilization review, utilization management, clinical review, concurrent review, retro review, medical review, interqual, milliman, medical necessity, registered nurse, discharge plan

    Job Requirements
    • Registered Nurse in the state of _____
    • 5+ years strong clinical skills
    • Utilization Review experience
    • Ability to navigate multiple computer systems and strong typing skills
    • Superior critical thinking & problem solving skills