Utilization Review Nurse Job Description Sample Template
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This free Utilization Review Nurse job description sample template can help you attract an innovative and experienced Utilization Review Nurse to your company. We make the hiring process one step easier by giving you a template to simply post to our site. Make sure to add requirements, benefits, and perks specific to the role and your company.
Utilization Review Nurse Job Summary
Our health clinic is looking for a Utilization Review Nurse who has experience with case management or other systems of managed care. In this role, you will compile and review the medical information of individual patients and the limited insurance coverage available to them. Your goal is to balance the quality of patient care with cost efficiency, ultimately maximizing the continuity of care a patient receives. As part of this role, you will consider the appropriateness or necessity of services before authorizing them or preparing cases for physician review. You will also deal with denials and appeals or work with patients to help them understand the limitations of their benefits. Applicants must have an RN license and clinical nursing experience.
Utilization Review Nurse Duties and Responsibilities
- Balance quality of care with cost efficiency
- Compile and review medical information and insurance coverage
- Authorize requested medical services
- Prepare cases for physician review
- Inform patients about their benefits and coverage limits
- Identify alternative, cost-effective resources
Utilization Review Nurse Requirements and Qualifications
- Bachelor's or master's degree in nursing
- Registered Nurse (RN) license
- Clinical nursing experience (2-4 years)
- Experience in care or utilization management (2+ years)
- BLS certification
- Computer proficiency
- Organizational skills
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