Utilization Management Registered Nurse
Core
Screen patient admissions against clinical criteria, manage denials, and serve as a clinical resource for staff.
Role type
Utilization Management Registered Nurse
Builds
Compliance with regulatory and organizational requirements for patient care utilization
Domain
Healthcare / Utilization Management
Required skills
Acute care hospital RN experience, Knowledge of UM regulations, Knowledge of payer reimbursement practices, Database software proficiency
Preferred skills
Pediatric experience, Case Management experience, Bachelors Degree in Nursing
Responsibilities
Daily screening of patient admissions, Active involvement in denial management, Communicate with payors to address concerns, Act as a resource to staff regarding clinical criteria
Seniority
Mid-level, hands-on IC
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