Utilization Review Nurse
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Job Title: Utilization Review Nurse (USRN)
Work Set-up: Onsite
Shift: Morning Shift | Fixed Weekends Off
Basic Function:
The Utilization Review Nurse is responsible for facilitating healthcare services, reviewing the appropriateness of requested treatments, and determining coverage based on health insurance policies for U.S. Government civilian employees. The role ensures high‑quality case management, proper medical referrals, and accurate documentation while upholding confidentiality and ethical standards.
Key Responsibilities
Review medical treatment requests and assess coverage eligibility.
Gather and evaluate clinical information to support case decisions.
Coordinate referrals to appropriate facilities or specialists.
Maintain accurate case documentation and uphold confidentiality.
Collaborate with internal teams and international counterparts.
Qualifications
PH and U.S. Registered Nurse licenses (valid ≥ 12 months).
BS Nursing graduate.
Minimum 5 years clinical experience; benefit review/BPO experience is a plus.
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