RN Utilization Management Nurse

Job Summary

A company is looking for an RN Utilization Management Nurse, preferably MST or EST, for a remote position.

Key Responsibilities

• Perform initial and concurrent reviews of inpatient cases using MCG criteria and consult with Medical Directors for adverse determinations
• Collaborate with healthcare professionals and Medical Directors to manage utilization and improve care progression
• Facilitate timely care and discharge planning while maintaining compliance with relevant regulations and identifying process improvements

Required Qualifications

• Current, unrestricted RN license in the resident state
• 1+ years of Utilization Management or Utilization Review experience
• 3+ years of total clinical experience in an inpatient or acute setting
• Experience in acute, long-term care, or skilled nursing facilities, including discharge planning
• Proficient in Microsoft Office Tools