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Registered Nurse (RN) Utilization Review - FMH
OverviewThe position is primarily accountable for performing initial clinical appropriateness reviews of requests for services that require prior authorization, initial, concurrent and/or retrospective review The review process is performed in accordance with established patient (health plan) protocols/guidelines, benefits, and clinical appropriateness criteria (clinical screening criteria). This position works closely with the Care Coordinators, Discharge Planners, Social Workers, Registration and Providers to evaluate, monitor, and assure the appropriateness and medical necessity of selected care for patients as it relates to quality, continuity, and cost-effectiveness. This position works with clinical and non-clinical staff as part of the referral and/or authori

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