Utilization Review RN
About The Position
As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization. Every day, you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria. To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.
Requirements
- Graduate of an accredited school of nursing required
- Minimum of 2 years of acute care experience in a hospital required OR Master's Degree in case management or nursing field in lieu of 1 year of experience and Bachelor's Degree in nursing
- Registered Nurse required
Responsibilities
- Review medical records
- Authorize services
- Prepare cases for physician review in partnership with UM teams
- Monitor patient care for appropriateness, quality, and cost-effectiveness
- Align decisions with established criteria
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
