POSITION SUMMARY:

The Utilization Review Registered Nurse (UR RN) is a key contributor to the delivery of appropriate, efficient, and cost-effective patient care. Working collaboratively within a multidisciplinary team, the UR RN conducts comprehensive reviews of clinical documentation, assesses medical necessity, and coordinates with healthcare providers and payers to support optimal patient outcomes and resource management. This role demands a solid clinical nursing background, sharp analytical skills, and a thorough understanding of regulatory standards and payer guidelines.

JOB-SPECIFIC RESPONSIBILITIES:

•Service 

oConsistently supports and communicates the Mission, Vision, and Values of Nexus Health Systems

oUpholds the Standards of conduct and corporate compliance.

oDemonstrates honest behavior in all matters. To the best of the employee’s knowledge and understanding, complies with all Federal and State laws and regulations.

oMaintains...