I had 7 years of experience working as Utilization review nurse/ case manager from prior authorization, admission, concurrent reviews, discharge and appeals of inpatient and outpatient services. I’m knowledgeable of using Cerner, interqual, MCG and Allscripts. My responsibilities also include schedule an appointment, check patient’s insurance eligibility, call facility to validate requested procedure and review for medical necessity using medical policies, process Medical director’s review including approvals, denials and modification.
