As an integrated care manager, specializing in Utilization review, the registered nurse will be responsible for utilization review services within the scope of licensure. Conducts primary function of prior authorization for inpatient and outpatient reviews both initial and concurrent continued stay review. Reviews for appropriateness of treatment setting to ensure compliance with applicable criteria, and regulatory requirements. Responsible for written and /or verbal communication of pertinent clinical information.
Virginia Remote, must be available to come into Virginia Beach office as required
Required:Minimum of 3 years acute care experienceRegistered NurseRequired – Verbal and Written Communication, Critical Thinking, Proficiency with basic computer skillsCertification :VA RN License (VABON) or North Carolina RN License (NCBON)Education:RN diploma, RN Associate Degree, RN Bachelor Level Degree or RN Master Level
keywords: LinkedIn, Nursing Acute Care, Full Time, Case Management, RN, Registered Nurse, BSN, ASN, utilization review, patient accounts, revenue cycle, Talroo-Nursing, utilization review