Georgia Licensed Utilization Management Nurse

Job Summary

To support efficient patient care, the full-time Georgia Licensed Utilization Management Nurse will conduct medical necessity reviews and collaborate with healthcare teams remotely, ensuring compliance with regulatory requirements and optimizing reimbursement processes.

Key responsibilities

• Conduct thorough medical necessity reviews to determine appropriate patient class designation
• Perform timely reviews of patient charts using InterQual Criteria and ensure documentation supports medical necessity
• Communicate effectively with provider teams regarding patient admissions and collaborate with various departments to enhance utilization management processes

Required qualifications

• Associate degree in nursing
• Minimum of 5 years of recent acute hospital experience or 2 years of utilization management experience
• Valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board
• Ability to meet quality and productivity expectations and complete yearly competencies
• Experience with InterQual Level of Care Criteria is preferred