PRN Clinical Utilization Review Specialist

The PRN Remote Clinical Utilization Review Specialist evaluates the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued stay reviews, supports denials and appeals activities, and collaborates with healthcare providers to facilitate efficient patient care. The specialist monitors adherence to hospital utilization review plans to optimize resource utilization, reduce readmissions, and maintain compliance with payer requirements.