RN - Utilization Review (Remote)

The Utilization Review Specialist is responsible for the assessment and review of the healthcare delivery system with a concentration on tasks that promote cost-effective quality care and cost containment in accordance with various federal and/or state statutes, regulations and guidelines as well as facility policy.

**Essential Duties and Responsibilities:**

+ Performs utilization review in accordance with all state mandated regulations
+ Analyzes insurance, governmental and accrediting standards to determine criteria concerning admissions, treatment, and length of stay
+ Assures compliance with state and federal regulations and billing requirements
+ Maintains compliance with regulation changes affecting utilization management
+ Reviews patient records and evaluates patient progress
+ Ensures high standard of patient care by establishing best practice benchmarks
+ Obtains and reviews necessary medical reports and related treatment plan to conduc...