Nurse Utilization Review II

Dublin, Ohio
Not Specified
Jul 08, 2018
Sep 06, 2018
Job Type
Not Specified
Career Level
Not Specified

York Risk Services Group is a premier provider of insurance, risk management, alternative risk, pool administration and claims management solutions to clients across hundreds of industries. Recently named by Forbes as one of "America's Best Midsized Companies Two Years in a Row" We firmly believe that our employees drive the success of the company. With success in mind as the ultimate goal, we strive to create and provide an environment that offers challenging, stimulating and financially rewarding opportunities.

Job Description

Conducts utilization reviews on the referrals received. Gathers, summarizes and reviews all medical documentation related to the requested services, compares request to applicable medical guidelines and completes review determination, referring to physician for final review as needed.


  • Collects medical information from providers, summarizes and enters information into the nurses notes in utilization review system
  • Requests additional medical information/documentation from the provider and adjuster as needed
  • Notifies appropriate parties of decision within the required time frame depending on state jurisdictional requirements
  • Becomes familiar with proper coding of services and diagnoses
  • Becomes proficient in the software used in the department
  • Contributes to the success of the company and its posture toward customer service by understanding and responding to our client's needs
  • Responsible for knowing and following various state jurisdictional requirements as well as URAC standards as applicable
  • Responsible for knowing confidentiality policies and procedures and adhering to them
  • Performs other duties as assigned


  • The Nurse, Utilization Review Services has no direct reports



  • BS / BA or Equivalent Work Experience
  • Must hold a current nursing license with a minimum of a Bachelor of Science in Nursing, Associate Degree in Nursing, Diploma in Nursing, or Licensed Practical Nursing in the state of residence


  • Two or more years clinical nursing experience in acute care setting with utilization review experience preferred


  • Must possess good oral and written communication skills; and the ability to work as a member of the Forte review team
  • Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement
  • Due to the nature of the position, sitting in a sustained position for prolonged periods of time is necessary
  • Vision must be adequate to view the computer screen.
  • Due to the varied nature of duties, prolonged sitting, frequent walking throughout the work area and standing for long periods of time are required
  • Hand dexterity is necessary for keyboard and/or telephone usage
  • Vision must be adequate for reading and viewing computer screen


  • Must possess knowledge of medical terminology, medical records, and appropriate medical coding systems
  • Must be computer literate

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