Registered Nurse - Clinical Utilization Reviewer - SUNYUPNYRN Job at NavitsPartners, Canton, MI

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  • NavitsPartners
  • Canton, MI

Job Description

Registered Nurse – Clinical Utilization Reviewer

Qualifications:

  • Current RN license in the state of practice.
  • At least 2 years of experience in utilization review or case management.
  • Knowledge of insurance reimbursement policies and pre-authorization processes.
  • Strong problem-solving and communication skills.
  • Experience with medical record review and healthcare data analysis.

Duties:

  • Review patient cases to assess medical necessity and appropriate treatment plans.
  • Verify insurance coverage and assist in authorization processes.
  • Work with providers to ensure proper documentation and regulatory compliance.
  • Identify opportunities for improving resource utilization.
  • Serve as a liaison between clinical staff and insurance companies.
  • Assist in developing utilization review policies and procedures.

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