Hybrid Utilization Review Nurse
Location: Uniondale, Long Island, Nassau County
Schedule: Monday to Friday, 8:30 AM - 5:30 PM
Join our team as a Utilization Review Nurse in a hybrid role that offers a mix of in-office and remote work. Based in Uniondale, Long Island, this position ensures the appropriate use of medical resources while delivering high-quality care management.
Conduct reviews to ensure proper utilization of medical services.
Evaluate patient records for service necessity and appropriateness.
Collaborate with healthcare providers to optimize outcomes.
Analyze clinical data to assess medical necessity.
Recommend actions using evidence-based guidelines.
Communicate with insurers to secure coverage and authorizations.
Maintain detailed documentation to meet compliance standards.
Participate in case management and care coordination meetings.
Experience & Skills Required
Active RN license in New York State.
At least 2 years of experience in utilization review.
Strong knowledge of medical terminology and healthcare services.
Excellent communication and interpersonal skills.
Self-starter with effective time management skills.
Proficiency with EHR systems and utilization management tools.
Detail-oriented with analytical and problem-solving expertise.