utilization Archives * fabriciano.mg.gov.br

6+ Remote Utilization Review Nurse Jobs: SimplyHired!

Opportunities exist for registered nurses to conduct utilization reviews on a part-time basis from a remote location. These roles, often advertised on job boards such as SimplyHired, involve assessing the medical necessity and appropriateness of healthcare services. For example, a nurse might review a patient’s medical records to determine if a hospital stay aligns with established clinical guidelines.

Such positions offer registered nurses increased flexibility and work-life balance while allowing them to leverage their clinical expertise in a non-traditional setting. Historically, utilization review was primarily conducted on-site within hospitals or insurance companies. The advent of secure electronic health records and improved communication technologies has facilitated the growth of remote utilization review roles, expanding opportunities for nurses nationwide.

7+ Best Utilization Review Nurse Job Description Examples

This role defines the responsibilities and requirements for registered nurses who evaluate the appropriateness and medical necessity of healthcare services. It outlines the qualifications, skills, and tasks associated with ensuring that patients receive the right care, in the right setting, at the right time. An example includes verifying that a hospital stay is warranted based on established clinical guidelines and the patient’s condition.

Proper performance of these duties leads to improved patient outcomes, cost containment for healthcare organizations, and compliance with regulatory standards. Historically, the need for this function arose from increasing healthcare costs and the desire to ensure efficient allocation of resources while maintaining quality patient care. This review process helps to avoid unnecessary procedures, hospitalizations, and other healthcare expenditures, thereby benefiting both patients and payers.