Utilization Management Nurse

Job Summary

A company is looking for a Utilization Management Nurse.

Key Responsibilities

• Perform concurrent and retrospective reviews of facility and home health services to monitor care quality and manage patient outcomes
• Determine observational vs acute inpatient status as part of the hospital prior authorization process
• Engage with providers for proactive discharge and transition planning, and coordinate interdisciplinary approaches to support continuity of care

Required Qualifications

• Minimum 2 years of clinical experience as an RN, LPN/LVN required
• Minimum 1 year of managed care or equivalent health plan experience preferred
• Experience in health plan utilization management and facility concurrent review discharge planning required
• Active unrestricted Nursing license required
• Experience with InterQual or MCG authorization criteria preferred