Registered Nurse - Utilization Review Case Manager - 10 Hour Days
About The Position
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
- strong clinical judgment
- efficiency in fast-paced environments
- proactive, collaborative communication style
Responsibilities
- performing real-time utilization review for surgical and procedural patients immediately following procedures
- ensuring accurate patient status determination (IP/OP/OBS)
- compliance with CMS and payer requirements
- timely documentation to support correct billing, regulatory adherence, and patient flow
- collaborating closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies
- initiating status changes when appropriate
- completing clinical reviews using CMS 2-Midnight, MCG, and InterQual criteria
- maintaining accurate census and handoffs
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What This Job Offers
Education Level
No Education Listed
Number of Employees
5,001-10,000 employees
