Registered Nurse – Clinical Utilization Reviewer - SUNYWNYRN

Registered Nurse – Clinical Utilization Reviewer

Qualifications:

• Current RN license in the state of practice.
• At least 2 years of experience in utilization review or case management.
• Knowledge of insurance reimbursement policies and pre-authorization processes.
• Strong problem-solving and communication skills.
• Experience with medical record review and healthcare data analysis.

Duties:

• Review patient cases to assess medical necessity and appropriate treatment plans.
• Verify insurance coverage and assist in authorization processes.
• Work with providers to ensure proper documentation and regulatory compliance.
• Identify opportunities for improving resource utilization.
• Serve as a liaison between clinical staff and insurance companies.
• Assist in developing utilization review policies and procedures.

Pay:

• Medium weekly pay range: $2,050 - $2,550