Registered Nurse Utilization Management

Job Summary

A company is looking for a Utilization Management RN to ensure efficient healthcare resource use while promoting quality patient care.

Key Responsibilities

• Coordinate with healthcare teams to assess and monitor the delivery of healthcare services
• Conduct utilization reviews and examine medical records for appropriateness of care
• Manage denials and appeals by reviewing cases and collaborating with physician advisors

Required Qualifications

• Bachelor's Degree in Nursing from an accredited college or university
• Master's Degree in Nursing preferred
• Three years of progressively responsible and directly related work experience
• Registered Nurse state licensure required
• Case Management Certification or Utilization Management Certificate within two years of hire