Utilization Review Nurse - Oregon

Only for registered members Oregon, United States

2 days ago

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Job summary

ICM is hiring a Utilization Review Nurse to support our Utilization Review team by evaluating medical necessity requests and reviewing ongoing hospital stays.

Responsibilities

  • Review precertification requests and determine medical necessity using evidence-based guidelines and plan-specific criteria
  • Evaluate clinical documentation for inpatient stays and make length-of-stay extension determinations when appropriate
  • Identify gaps in clinical information and communicate clearly with providers to obtain what's needed to support timely decisions
  • Select other responsibilities from the job description.

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