What are the responsibilities and job description for the Utilization Review RN position at Care Crafter Health?
Job Type: Contract
Job Category: Nursing
Job Description
Job Title: Utilization Review RN Trainer
Job Summary:
We are seeking a skilled and dedicated Utilization Review RN Trainer to join our healthcare team. The ideal candidate will have strong clinical knowledge, a passion for teaching, and experience in utilization review. This role will be responsible for training and mentoring Registered Nurses (RNs) involved in the utilization review process, ensuring compliance with health insurance guidelines, and improving overall patient care management.
Key Responsibilities:
Develop and deliver training programs for Registered Nurses (RNs) on utilization review processes, protocols, and best practices.
Ensure staff understands guidelines for pre-certification, authorization, and medical necessity reviews.
Stay up to date on the latest insurance policies, medical necessity criteria, and regulations.
Provide ongoing support to staff to improve their skills and competency in utilization management.
Monitor and assess the quality of reviews completed by nursing staff and provide feedback for improvement.
Collaborate with case management, clinical, and quality assurance teams to ensure efficient and effective care coordination.
Assist with audits and quality improvement initiatives.
Promote a patient-centered approach to care while maintaining cost-effective and clinically appropriate services.
Document training activities and maintain accurate records.
Qualifications:
Registered Nurse (RN) with an active, unencumbered license.
Minimum of 3 years of clinical nursing experience (preferably in utilization review, case management, or a similar field).
Strong understanding of healthcare regulations, payer requirements, and clinical guidelines.
Excellent communication, presentation, and interpersonal skills.
Ability to work independently and manage multiple priorities.
Experience in training, coaching, or mentoring nursing staff is preferred.
Certification in Utilization Review (e.g., URAC, CCM) is a plus.
Preferred Skills:
Advanced clinical knowledge in various specialties (e.g., oncology, cardiology).
Knowledge of EMR systems and utilization review software.
Strong problem-solving and decision-making skills.
Why Join Us:
Competitive salary and benefits package.
Collaborative and supportive team environment.
Opportunities for career advancement and professional growth.
Work with an innovative healthcare team focused on high-quality patient care.
Hashtags:
#UtilizationReview #RNTrainer #NursingJobs #HealthcareTraining #ClinicalTraining #RegisteredNurse #CaseManagement #PatientCare #RNJobs #HealthcareCareers #NursingOpportunities #TrainingAndDevelopment
Required Skills
REGISTERED NURSE
