Utilization Review Nurse I

  • Location

    Nashville, United States

  • Sector:

    Other Area(s)

  • Job type:


  • Contact:

    Leric Arcigal

  • Job ref:


  • Published:

    about 1 year ago

  • Expiry date:


Manager would like sourcing in the following four locations. Manager will select whichever candidates are the best fits in any location. Does not need specific headcount in specific locations. Please specify which location candidate resides in on their resume. 1601 Chestnut Street 2 Liberty Place Philadelphia PA 19192 530 Great Circle Road, Nashville TN, 37228 2100 RIVERCHASE CENTER BIRMINGHAM, AL, 35244 525 W MONROE CHICAGO, IL, US 60661

Delivers specific delegated tasks assigned by a supervisor in the Utilization Management job family.

Determines whether services provided to plan members were actually medically necessary.

Develops and maintains knowledge of provider organization review procedures.

Maintains reporting system for Utilization Review.

Completes day-to-day Utilization Review tasks without immediate supervision, but has ready access to advice from more experienced team members.

Tasks involve a degree of forward planning and anticipation of needs/issues.

Resolves non-routine issues escalated from more junior team members.

Requires a RN.