Utilization Review Clinician - RN - Remote

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity, conducting patient evaluations, managing admissions, and ensuring post-discharge visits occur within the required timeframe. They assess requests for post-acute services using clinical guidelines, build relationships with healthcare providers, and coordinate care with facilities. Responsibilities include conducting prior authorization and continued stay reviews, approving services in compliance with guidelines, and collaborating with case managers and medical directors. The role involves participating in team meetings, educational activities, and interrater reliability testing, as well as ensuring compliance with federal, state, and accreditation standards. They will also support payer programs, make benefit determinations, coordinate benefits, and utilize knowledge of healthcare system resources.