Inpatient Utilization Management Nurse RN

Job Summary

A company is looking for an Inpatient Utilization Management Nurse RN.

Key Responsibilities:

• Conducts clinical reviews for appropriate utilization of medical services using medical necessity criteria
• Documents clinical reviews and prepares cases for medical appropriateness review with the Medical Director
• Collaborates with the Medical Management team for care coordination and identifies members for care coordination programs

Required Qualifications:

• Current unrestricted Registered Nurse (RN) license in state of residence
• 3+ years of clinical nursing experience in an acute care hospital or LTAC setting
• 1+ years of Utilization Management experience in a hospital or insurance setting
• Experience applying Medicare and/or Medicaid guidelines
• Experience with Milliman (MCG) or InterQual guidelines