Utilization Review/Outpatient Care RN

Job Title: Utilization Review/Outpatient Care RN

Are you an experienced Registered Nurse with Utilization Review experience looking for a new opportunity with a prestigious healthcare company? Do you want the chance to advance your career by joining a rapidly growing company? If you answered “yes" to any of these questions – this is the position for you!

Position Summary:

As the Utilization Review/Outpatient Care RN, you would be responsible for reviewing and collecting medical information in order to determine medical necessity of services requested.

Hours for this Position: Monday-Friday daytime hours (40 hours/week)

Advantages of this Opportunity:

• Pay $28-$32 per hour, negotiable based on experience

• Work for a prominent Healthcare company who pride themselves on partnership, integrity, teamwork, and accountability

• Be a part of a team who serves the full spectrum of member needs

• Weekly deposit options

• Great benefits offered

More Insight of Daily Responsibilities: 

• Ensures that services provided to eligible members are within benefit plan 

• Initiates and continues direct communication with health care providers involved with the care of the member 

• Identifies appropriate clinical settings for services being requested

• Identifies and refers cases appropriate for case management

• Identifies potential quality of care issues and refers to Quality Department

• Determines appropriate utilization management of services requested