Utilization Review Nurse

Perform medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines. Obtain information via telephone and fax to assess member's clinical condition and apply evidence-based guidelines. Meet decision-making SLAs and refer members for further care engagement when needed. Requires active unrestricted RN licensure (compact or specific state), associate degree or nursing diploma, 1+ year UR experience in managed care, strong MCG experience, and 1+ year clinical practice in acute care setting. Weekend availability required. BSN preferred.