Job Description

Registered Nurse – Outpatient Utilization Review Nurse

Qualifications:

• RN license with experience in outpatient case management or utilization review.
• Minimum of 2 years of experience in ambulatory or outpatient settings.
• Strong understanding of medical necessity criteria for outpatient services.
• Familiarity with managed care policies and insurance guidelines.
• Excellent organizational and analytical skills.

Duties:

• Evaluate the appropriateness of outpatient procedures and treatments.
• Work with healthcare providers to streamline pre-authorization processes.
• Monitor resource utilization and recommend cost-effective care strategies.
• Analyze outpatient case data and ensure compliance with payer regulations.
• Assist in coordinating referrals and follow-up care.
• Educate providers on best practices for utilization management.

Pay:

• Medium weekly pay range: $2,000 - $2,500

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