The Utilization Review Nurse acts as a patient and organizational advocate. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost-efficient patient outcomes. Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained. Applies review criteria to determine medical necessity for admission and continued stay. Provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care. The Utilization Review Nurse assists the nurse case manager, social worker, and physician to ensure the right care is provided at the right time every time by focusing on the person and family and ensures the patient's active participation and decision making in their care. Works collaboratively with interdisciplinary staff internal and external to the organization. Participates in quality improvement and evaluation processes related to the management of patient care. The Utilization Review Nurse is on-site and available seven days a week, as well as holidays and, therefore, is required to work a weekend rotation and an occasional holiday.