Utilization Review Nurse (RN)

· The incumbent must possess medical management/clinical decision-making skills and sound skills in assessing, planning and managing member care.

· Advanced assessment and teaching skills.

· Problem solving skills.

· Familiarity with legal terminology and liability issues and ability to handle ethical or risk management issues.

· Utilization and Quality Management/Outcomes experience preferred.

· Previous work experience with a managed care organization or provider is also preferred.

· Prior experience in case management, home health, discharge planning, or Concurrent review.