Utilization Review Nurse

Job Overview

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, but that and prefers working in a professional office setting with daytime office hours and weekends/holidays off.

This position is responsible for working telephonically with providers to evaluate and pre certify requests such as hospital stays, outpatient surgeries, outpatient tests, care, etc. Review requests and match up to an evidence based guideline to ensure proper care and ensure the right service is happening at the right time and is medically necessary. In this position you will be handling multiple provider phone calls at any given time and need to be able to handle a very fast paced environment. You will also work closely with participants for referrals to case management and disease management services according to referral criteria and health plan guidelines.

Qualified candidates will have an RN and clinical experience, preferably in ER, ICU, and/or pain management. Bilingual is also preferred.