Onsite Nurse RN

Role Overview: The on-site Hospital Utilization Management (UM) Nurse acts as a vital link between clinical teams and administrative compliance, providing face-to-face interaction with physicians, patients, and interdisciplinary staff. Key Responsibilities Perform admission and concurrent medical record reviews to ensure accurate patient classification and optimize hospital throughput, length of stay, and reimbursement.Collaborate with physicians and clinical staff through in-person consultations and bedside rounds to discuss cases, medical necessity, and appropriate care levels.Utilize criteria like InterQual or MCG for real-time medical necessity reviews and deliver legally required notices directly to patients.Identify and escalate avoidable days to minimize financial loss, ensuring compliance with payer regulations and documentation standards.Support continuous improvement initiatives, assess coverage requirements, and ensure accurate documentation for post-discharge and billing processes. Qualifications & Skills Registered Nurse (RN) license, with multi-state or single-state certification.Minimum of 3 years of clinical experience with strong knowledge of case management processes.Proficient in clinical documentation, screening criteria, and analyzing variances.Excellent verbal and written communication, organizational, and relationship-building skills.Strong computer skills and ability to think critically to influence care and throughput improvements.