Utilization Review Nurse

• Review medical records to determine the medical necessity of a request for medical services.
• Validate diagnosis and corresponding algorithms of care.
• Evaluate for over-utilization of treatment requests inconsistent with evidence based guidelines.
• Communicate with the claims examiner, providers, and any other auxiliary provider regarding UR determination.
• Summarize medical records and all pertinent information for Physician Advisor.
• Identify the need for medical case management and make recommendations for referral through supervisor.

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Temp LVN/LPN – Utilization Review Nurse