RN Inpatient Utilization Management

Job Summary

A company is looking for an Inpatient Utilization Management Clinician.

Key Responsibilities

• Perform utilization review activities including concurrent and retrospective reviews of inpatient cases
• Obtain clinical information to assess and expedite timely decisions on inpatient services
• Monitor inpatient cases for compliance with contractual obligations and regulatory requirements

Required Qualifications, Training, and Education

• Active, unrestricted RN license in state of residence
• Nursing degree or diploma required, with a bachelor's degree in nursing preferred
• 2+ years of utilization review experience and knowledge of evidence-based guidelines (InterQual Guidelines)
• Experience in managed care and performing discharge planning
• Knowledge of Medicare and Medicaid regulations