Registered Nurse - Utilization Review Case Manager - 10 Hour Days
About The Position
Job Summary: Key Job Responsibilities The Post-Procedure Utilization Management (UM) Registered Nurse is responsible for performing real-time utilization review for surgical and procedural patients immediately following procedures. This role ensures accurate patient status determination (IP/OP/OBS), compliance with CMS and payer requirements, and timely documentation to support correct billing, regulatory adherence, and patient flow. The Post-Procedure UM RN collaborates closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies, initiate status changes when appropriate, complete clinical reviews using CMS 2-Midnight, MCG, and InterQual criteria, and maintain accurate census and handoffs. This position requires strong clinical judgment, efficiency in fast-paced environments, and a proactive, collaborative communication style
Requirements
- Assoc. Degree/College Diploma
- Graduate of an accredited nursing program
- Bachelor's Degree
- RN State License
- Basic Life Support (BLS)
- 3 years in acute nursing
- 2 years Case Management
- 1 year CPT coding
- Lifting 50 lbs.
- Carrying 50 lbs.
- Pushing 75 lbs.
- Pulling 75 lbs.
- Balancing, Stooping, Kneeling, Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions, Eye/Hand/Foot Coordination
Responsibilities
- performing real-time utilization review for surgical and procedural patients immediately following procedures
- ensures accurate patient status determination (IP/OP/OBS)
- compliance with CMS and payer requirements
- timely documentation to support correct billing, regulatory adherence, and patient flow
- collaborates closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies
- initiate status changes when appropriate
- complete clinical reviews using CMS 2-Midnight, MCG, and InterQual criteria
- maintain accurate census and handoffs
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What This Job Offers
Education Level
Associate degree
Number of Employees
5,001-10,000 employees
