Utilization Review Nurse

Public Consulting Group

US
Base: $76,000 - $85,000; bonus/equity: not specifi...
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Prior authorization, concurrent and retrospective reviews
Medical management software system
Clinical documentation and review criteria
** Public Consulting Group (PCG) is seeking a Utilization Review Nurse to perform medical management activities, including prior authorization and clinical reviews, within a supportive public sector environment. The ideal candidate should possess a nursing degree, relevant experience in clinical and medical management settings, and strong communication and organizational skills. **

Job Summary

  • PCG is seeking a Utilization Review Nurse to perform prior authorization, concurrent and retrospective reviews using clinical documentation and review criteria.
  • The role involves accurate recording of review determinations, contacting providers and members, and identifying cases that do not meet established criteria.
  • This is a remote position requiring strong computer skills, excellent customer service, and the ability to work in a fast-paced environment.

Matching Summary

Match Score: 75

** Public Consulting Group (PCG) is seeking a Utilization Review Nurse to perform medical management activities, including prior authorization and clinical reviews, within a supportive public sector environment. The ideal candidate should possess a nursing degree, relevant experience in clinical and medical management settings, and strong communication and organizational skills. **

Salary

Base: $76,000 - $85,000; Bonus/Equity: Not specified; Benefits: medical and dental care benefits, 401k, PTO, parental leave, bereavement leave

Skills & Requirements

Must-have

  • Prior authorization, concurrent and retrospective reviews
  • Medical management software system
  • Clinical documentation and review criteria
  • Provider and member contact
  • Quality of care issue identification

Nice-to-have

  • Positive attitude and proactive style
  • Courteous and competent demeanor
  • Team-oriented and responsible

Key Requirements

  • Associate Degree, Bachelor’s preferred
  • Minimum 2 years direct clinical nursing experience
  • Minimum 2 years medical management experience
  • RN required

Work Rights

Not specified

Tailored Resume

Cover Letter