Registered Nurse Utilization Management

Job Summary

Providing comprehensive utilization management, the full-time Registered Nurse Utilization Management will manage pre-certification and concurrent review processes, ensuring optimal healthcare outcomes while working remotely.

Key responsibilities

• Conduct pre-certification and concurrent reviews to determine medical necessity and appropriate lengths of stay for various admissions
• Assist with discharge planning and identify alternative treatment plans while ensuring compliance with benefit plans
• Evaluate treatment plans for cost-effectiveness and refer to appropriate care management resources as needed

Required qualifications

• 5+ years of relevant work experience in clinical nursing and patient assessment
• Graduate of an accredited nursing school with a valid RN license in good standing
• Knowledge of medical terminology and cost containment practices in healthcare
• Preferred Bachelor's degree in nursing and experience in utilization management or case management
• Proficiency in collaborating with cross-operational teams and maintaining client confidentiality