Utilization Management Registered Nurse RN

**Employment Type:**
Full time
**Shift:**
Day Shift

**Description:**

**Position Summary**

The Utilization Management (UM) Registered Nurse is responsible for reviewing medical services and treatment plans to ensure the delivery of appropriate, cost-effective, and high-quality patient care. Using established clinical guidelines, regulatory requirements, and health plan policies, the UM RN collaborates with providers, interdisciplinary care teams, and patients to support optimal health outcomes while promoting the efficient use of healthcare resources.

**Key Responsibilities**

+ Conduct concurrent utilization reviews to determine and validate the appropriate level of care using established criteria, including InterQual and Milliman guidelines.
+ Initiate, manage, and track admission authorizations and payer communications.
+ Review and monitor insurance denials, support appeals processes, and identify opportunities for utilizati...