Utilization Review Nurse - Remote Opportunity in the United States

Summit Medical Staffing is seeking a dedicated Utilization Review Nurse to join our team remotely across the United States. This full-time position plays a vital role in healthcare by conducting thorough clinical assessments to ensure patient care complies with healthcare regulations and standards.

Key Responsibilities

• Perform detailed clinical assessments to evaluate the necessity and appropriateness of healthcare services provided.
• Review patient records and treatment plans to verify compliance with healthcare regulations and policies.
• Communicate effectively with healthcare providers to gather additional clinical information when necessary.
• Analyze patient data to identify trends and opportunities for improving service utilization and patient outcomes.
• Document evaluations and decisions clearly, maintaining accuracy in accordance with regulatory standards.
• Collaborate with nursing and healthcare teams to optimize patient care and resource use.
• Manage caseloads independently, ensuring timely completion of reviews and adherence to deadlines.

Required and Preferred Qualifications

• Bachelor's Degree in Nursing (BSN) required.
• Proven clinical assessment skills and strong knowledge of healthcare regulations.
• Excellent communication and interpersonal skills to liaise with healthcare professionals effectively.
• Critical thinking abilities to evaluate patient care needs and utilization effectively.
• Ability to work independently with strong time management skills.
• Experience in utilization review is preferred but not mandatory.

This role reports directly to the Utilization Review Manager and involves collaboration with a multidisciplinary healthcare team including nurses and administrative staff. Your expertise will directly impact patient care quality and ensure regulatory compliance within the healthcare system.

Location: Remote - United States

Employment Type: Full-time