RN - Utilization Management

Utilization Management Registered Nurse (UM RN)

Job Summary

We are seeking an experienced and detail-oriented Utilization Management Registered Nurse (UM RN) to join our hospital team. The UM RN is responsible for reviewing patient cases to ensure appropriate utilization of healthcare services, medical necessity, compliance with payer requirements, and optimal patient outcomes. This role collaborates closely with physicians, case managers, and interdisciplinary teams to support quality patient care while managing healthcare resources efficiently.

Key Responsibilities

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  Perform utilization review activities for inpatient and outpatient services.

  
  


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  Assess medical necessity, level of care, and appropriateness of admissions using established criteria such as InterQual or MCG guidelines.

  
  


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  Collab...