Full employer posting
About the Position Specialty: RN – Utilization Review
2+ years of experience in utilization review, case management, or acute care nursing License: Active State or Compact RN License
BLS – AHA; Certified Case Manager (CCM) preferred Must-Have: Strong understanding of insurance guidelines, medical necessity criteria (e.g., InterQual or MCG), and discharge planning Description: The Utilization Review RN is responsible for reviewing medical records to determine the appropriateness and medical necessity of hospital admissions and continued stays. The nurse collaborates with providers, insurance companies, and case managers to ensure compliance with coverage guidelines and supports optimal patient outcomes while managing healthcare costs.
Requirements Required for Onboarding: Active RN License BLS