RN Utilization Management Clinician

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
• Monitor inpatient cases for compliance with contractual obligations and regulatory requirements
• Collaborate with care management and medical directors to facilitate discharge planning and improve care transitions

Required Qualifications, Training, and Education:

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