Utilization Review Nurse RN - PRN
Alpha Home Health and Hospice · Owings Mills, MD · 2 mo ago
HealthcareFull-time
About the role
Evaluates hospital stays for medical necessity, coordinates with physician advisors, and manages denials in collaboration with Case Management. Supports the Emergency Department on an as-needed (PRN) basis while ensuring compliance with insurance and hospital policies.
Responsibilities
- Review patient stays to ensure appropriate resource utilization
- Monitor hospital resource use
- Refer cases to physician advisors as needed
Requirements
- Current RN license
- At least 2 years of inpatient Emergency Department utilization review experience
- Residency in specified districts/states
Qualifications
- BSN or ADN (preferred)
Skills
- Clinical judgment
- Resource management
- Effective communication