Utilization Management Registered Nurse

Wellstar Health Systems, Marietta, Georgia, US

About the Role

The on-site Utilization Management Registered Nurse reviews patient records and care plans to assess medical necessity, patient classification, and appropriate level of care. The nurse collaborates with physicians and interdisciplinary teams, applies screening criteria, supports care progression, monitors payer and Medicare/Medicaid compliance, and helps prevent denials through timely documentation and escalation.

Responsibilities

  • Collaborates with physicians and interdisciplinary teams
  • Applies screening criteria
  • Monitors payer and Medicare/Medicaid compliance

Qualifications

  • RN licensure in applicable state
  • Experience in utilization management or case management preferred
  • Knowledge of medical necessity criteria and level of care determination

Benefits

On-site role

Required Skills

utilization management nursing care coordination case management compliance

Keywords

Utilization management nursing healthcare case management compliance

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