Wisconsin Licensed Utilization Management Nurse

Job Summary

A company is looking for a Clinical Utilization Management Nurse - Per Diem.

Key Responsibilities

• Perform admission, concurrent, and discharge reviews to assess medical necessity and appropriate level of care
• Collaborate with physicians and care teams to ensure compliance with documentation and payer requirements
• Document utilization review findings and participate in interdisciplinary rounds to enhance patient care

Required Qualifications

• High School Diploma/GED (or higher)
• Active, unrestricted RN license in the state of Wisconsin
• 3+ years of experience in utilization review or case management in an acute care setting
• 3+ years of experience with InterQual/MCG criteria, CMS regulations, and payer guidelines
• Intermediate proficiency in electronic medical records and utilization management software