We are seeking an experienced Utilization Review Nurse to join our team in a hybrid role based in Uniondale, Long Island, Nassau County. This position offers a unique blend of in-office and remote work, providing flexibility while ensuring high-quality care management.
Hybrid Utilization Review Nurse (Uniondale, LI Nassau County)
Position: Utilization Review Nurse
Location: Uniondale, Long Island, Nassau County (Hybrid: In Office/Remote)
Schedule: Monday to Friday, 8:30 AM - 5:30 PM
Conduct utilization reviews to ensure appropriate use of medical resources.
Evaluate patient medical records to determine the necessity and appropriateness of services.
Collaborate with healthcare providers to facilitate optimal patient outcomes.
Review and analyze clinical information to support the determination of medical necessity.
Provide recommendations based on evidence-based guidelines and protocols.
Communicate with insurance companies to ensure coverage and authorization of services.
Document all review activities in accordance with regulatory and compliance standards.
Participate in case management and care coordination meetings.
Experience & Skills Required
Active RN license in the state of New York.
Minimum of 2 years of experience in utilization review.
Strong understanding of medical terminology and healthcare services.
Excellent communication and interpersonal skills.
Ability to work independently and manage time effectively.
Proficiency in electronic health records (EHR) and utilization management software.
Detail-oriented with strong analytical and problem-solving abilities.
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