Job Description

To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization review activities, ensuring appropriate patient status determinations and compliance with regulatory requirements while working remotely. Key responsibilities: Conduct medical necessity reviews and patient status determinations using approved clinical criteria and organizational policies Manage payer authorization processes to promote timely approvals and reduce financial risk Collaborate with interdisciplinary teams to support appropriate patient progression and discharge planning Required qualifications: Registered Nurse license is required Bachelor's degree is required 2+ years of Acute Hospital Care experience is required Experience with Interqual and MCG is preferred Previous Utilization Management, Appeals, or Denials Management experience is preferred

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