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Utilization Review Nurse
Career Insights for Registered Nurse (General)
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What they do
A Registered Nurse provides medical care and treatment, educates patients about their conditions, and provides emotional support to patients and families. Works in hospitals, schools, clinics or community health centers. Works under the supervision of a physician or other specialist, and serves as the primary point of care for patients in a hospital setting. May specialize in emergency room work, or treatment for a particular condition, or specialize in working with infants, the elderly or other patient groups. May work as an advanced practice specialists and prescribe medications in addition to offering specialty care.
$86,436 / year median in the U.S.
+13% projected growth
Job Description
Type:
full-timeJob Description:
100% remote but would need to go to Newark, NJ first day to pick up equipment and orientation Review insurance claims- Analyze medical records and documentation
- Compare cases with clinical guidelines and insurance policies
- Write appeal recommendations or determinations
- Work with providers, insurance companies, and case managers
- Ensure decisions follow regulatory and medical necessity standards