Utilization Review Nurse

Green Key Resources cares deeply about developing personal, lasting relationships with our clients. Our recruitment team consists of seasoned, passionate professionals who leverage intricate industry knowledge and an incredible network to find talented people and align them with the right career. People, not just candidates. Careers, not just jobs. We look at recruitment as a philosophy, and our recruiters are dedicated to a holistic approach in which we first consider the big picture and then go on to match skills, goals, dreams, corporate culture, and more. Our business, and yours, is changing and growing every day. That’s why we’re constantly investing in the newest analytical tools available. New, innovative departments like our in-house Research & Development team is available to provide customized solutions for both career seekers and companies. As the recruiting world begins to rely more and more on technology to find and match talent, we will always remain loyal to the power of the human touch - never underestimating how far it can take both our candidates and clients.

Conduct timely and accurate reviews of inpatient and outpatient medical records to determine medical necessity and level of care. Apply evidence-based criteria (e.g., InterQual, MCG) and hospital policies to support clinical decision-making. Communicate with physicians and clinical staff to clarify documentation and support utilization decisions. Submit clinical reviews to insurance companies and respond to requests for additional information. Monitor patient status and ensure appropriate documentation for continued stay reviews. Maintain compliance with federal, state, and payer-specific regulations. Accurately document all review activities in the hospital’s electronic medical record (EMR) and UR platforms (e.g., XSOLIS/Dragonfly).