Utilization Review Registered Nurse : On Site Position
$33,500–$53,000 year
On-site · Meeker, Colorado, United States
Job Summary
The Part-Time Utilization Review Nurse is a Registered Nurse (RN) responsible for conducting utilization reviews to determine the medical necessity and appropriateness of patient admissions and continued hospital stays. Responsibilities include performing concurrent and retrospective utilization reviews, communicating with healthcare providers about medical necessity, addressing discharge barriers, documenting review activities in the electronic health record, assisting with appeals, and participating in interdisciplinary team meetings. Candidates must have a valid RN license, recent acute care experience, and knowledge of related regulations.
Required Qualifications
- Active, unencumbered Registered Nurse (RN) license in Colorado or Compact-state license that includes Colorado.
- Two (2) to three (3) years’ of recent clinical experience in an acute care setting required.
- Previous experience in managing staff and schedules required.
Desired Qualifications
- One (1) year of experience in Utilization Review or Case Management preferred.
- Strong knowledge of Medicare, Medicaid, and commercial payer regulations, as well as medical necessity criteria (e.g., InterQual, Milliman Care Guidelines).
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