Utilization Management Nurse

A company is looking for a Utilization Management Nurse to review and monitor healthcare service utilization for quality and cost-effectiveness.

Key Responsibilities

Conducts concurrent and retrospective reviews of healthcare services to improve quality outcomes and reduce costs

Determines patient status during the hospital prior authorization process and engages in proactive discharge planning

Coordinates interdisciplinary care and manages utilization reports to ensure compliance and continuity of care

Required Qualifications

Minimum 2 years of clinical experience as an RN, LPN / LVN required

Preferred 1 year of managed care or equivalent health plan experience

Experience in health plan utilization management and discharge planning required

Active unrestricted Nursing license required

Experience with InterQual or MCG authorization criteria preferred