Utilization Review Nurse

The Utilization Review Nurse at Premera performs prospective, concurrent, and retrospective medical necessity reviews to determine the appropriate clinical requests from providers. This role involves partnering with Medical Directors and various departments to ensure cost-effective care and compliance with medical policies and accreditation requirements. Incumbents apply critical thinking and clinical knowledge to assess inpatient admissions, outpatient services, and benefit applications across all business lines and regions.