Utilization Management Nurse, Senior
About The Position
The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information provided by the facilities to determine medical necessity when our members admit. You will also be involved with discharge planning and transfers as needed for higher levels of care or out of network admissions.
Responsibilities
- Review inpatient stays for members.
- Apply guidelines for nationally recognized levels of care.
- Review clinical information to determine medical necessity.
- Discharge planning.
- Coordinate transfers as needed.
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What This Job Offers
Career Level
Senior
Industry
Religious, Grantmaking, Civic, Professional, and Similar Organizations
Education Level
No Education Listed
