Rising Medical Solutions

Nurse

• Perform all aspects of the Utilization Review Process
• Review records and requests for utilization review received via mail, email, fax, or phone
• Use evidence-based guidelines to determine authorization or refer files for Peer or Physician Review
• Write nurse summaries on all utilization review files
• Document in Rising's and client databases and send determination letters
• Establish collaborative relationships with clients, patients, employers, providers, and attorneys
• Track utilization review activity to meet turnaround times
• Maintain organized files containing clinical documentation of claim interactions
• Apply clinical judgment, careful listening, critical thinking, and assessment skills
• Respond to written and telephone inquiries regarding case status
• Use a computer and multiple software programs simultaneously

Explore Utilization Review Nurse at Rising Medical Solutions. Review requirements and application details.