Nurse, Concurrent Review
Core
Performs concurrent inpatient utilization review using InterQual criteria to determine medical necessity for admission, continued stay, and transitional care.
Role type
Senior Utilization Review Nurse (Clinical)
Builds
Medical necessity determinations and level-of-care decisions for inpatient patients
Domain
Healthcare / Utilization Management
Required skills
RN licensure, acute care nursing experience, InterQual criteria application, regulatory compliance knowledge, Microsoft Office proficiency, critical thinking
Preferred skills
Inpatient clinical nursing experience, utilization management experience, InterQual certification, payer-specific utilization review knowledge
Technologies
InterQual, Microsoft Office (Word, Excel, PowerPoint), HIPAA-compliant portal
Responsibilities
Perform admission, continued stay, and transitional care reviews; collaborate with physicians and care teams; document clinical rationale; resolve escalated cases; ensure regulatory compliance; maintain confidentiality
Seniority
Mid-level, hands-on IC