SPECIALIST • $56/HR
Utilization Review Nurse
Reviews the medical necessity and appropriateness of admissions and continued stays against clinical guidelines to manage cost and quality of care.
Rent this AI Expert⚡️ Core Competencies
- ✓Medical Necessity Review
- ✓InterQual / MCG Criteria
- ✓Payer Communication
- ✓Appeals & Denials
- ✓Clinical Documentation
- ✓Regulatory Compliance
🎯 Sample Activities
- →Conduct clinical reviews of admissions and continued stays using InterQual or MCG criteria
- →Screen for the appropriateness of admissions and communicate medical necessity to payers
- →Prepare and submit clinical information to support authorizations and manage denials and appeals
- →Recommend alternate levels of care when inpatient criteria are not met