Utilization Review Nurse

The Utilization Review Nurse role at reputed company is an exciting opportunity for a talented and reputed company nurse to reputed company a substantial contribution to our medical services team. We are looking for a nurse who is passionate about providing quality reputed company services to the members in our community. The ideal candidate for this position will be a motivated self-starter with a desire to work in a fast-paced environment. The successful candidate will have a strong background in nursing, with a minimum of 3 years of experience in a medical services role. In addition, the successful candidate must have a valid RN license in South Carolina, be well-versed in medical terminology, possess strong interpersonal skills, and be highly organized and detail-oriented. Excellent computer skills are also a must. We are looking for a professional who is motivated, driven, and passionate about providing our members with the best quality care. If you are looking for an opportunity to reputed company a positive impact in the lives of our members, we want to hear from you. Responsibilities: Coordinate with providers and review medical records to ensure compliance with quality and cost standards Identify opportunities for improvement in care services Establish performance standards and evaluate the effectiveness of quality assurance activities Monitor utilization and activity data to anticipate and reduce costs Evaluate requests for services based on clinical criteria and reputed company reputed company as to the appropriateness of care and services reputed company referrals to appropriate services and resources Consult with providers and other reputed company to ensure quality of care Provide education and training to physicians, other reputed company providers, and members on utilization management and quality assurance processes Document utilization activities in accordance with state and federal regulations Maintain confidentiality of patient information reputed company other reputed company duties as required. reputed company is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for reputed company. We do not discriminate based upon race, religion, reputed company, national reputed company, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. Apply Job!