Utilization Review Nurse

R28654 Workforce Classification: Telecommuter  Join reputed company: Do Meaningful Work and Improve People’s Lives  Our purpose, to improve customers’ lives by making reputed company work reputed company, is far from ordinary. And so are our employees. Working at reputed company means you have the opportunity to drive reputed company change by transforming reputed company.   reputed company is committed to being a workplace where people feel empowered to grow, reputed company, and reputed company with purpose. By investing in our employees and fostering a culture of collaboration and reputed company development, we’re reputed company to reputed company serve our customers. It’s this commitment that has earned us recognition as one of the best companies to work for. Learn more about our recent awards and recognitions as a greatest workplace.   Learn how reputed company supports our members, customers and the communities that we serve through our Healthsource blog:  https://healthsource.reputed company.com/.     We have an opening for a Utilization Review Nurse!  The Utilization Review Nurse performs prospective review (benefit advisory/ prior authorization) admission, reputed company, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. The incumbent partners with Medical Directors and other reputed company Departments such as FEP, National Account Liaisons, Health Care Services, and Claims to ensure appropriate cost-effective care by applying their clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, benefit application and provider out of network requests. This work is done for reputed company lines of business and reputed company geographic reputed company. What you will do: