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 based on medical necessity criteria
• Documents clinical reviews and decisions in the care management system accurately and timely
• Collaborates with the Medical Management team to coordinate care for members and prepares clinical information for case review

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 and using Milliman (MCG) or InterQual guidelines
• Ability to work a flexible schedule including one weekend day after the training period