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CORE Occupational Medicine

Port Isabel, Texas

FIFCO USA

Rochester, New York

Trane Technologies

Clarksville, Tennessee

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Registered Nurse (RN) Utilization Reviewer (PRN)
Job DescriptionGeneral SummaryUnder general supervision, provides utilization review and denials management for an assigned patient case load. This role utilizes nationally recognized care guidelines/criteria to assess the patient's need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers. Staff assigned to this position are not scheduled to work sufficient hours to qualify for FLSA Exempt status.Principal Responsibilities and TasksPerforms timely and accurate utilization review for all patient populations, using nati


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