Onsite RN Nurse

Role Overview: An on-site Hospital Utilization Management (UM) Nurse serves as the key link between clinical staff and administrative compliance, ensuring optimal hospital resource use through real-time, face-to-face interactions with physicians, patients, and interdisciplinary teams. Responsibilities Include Collaborating with physicians and clinical teams to review and discuss patient cases, documentation, and medical necessity.Participating in bedside rounds and departmental huddles to provide immediate input on care progression and appropriate level of care.Conducting concurrent medical record reviews using criteria like InterQual or MCG to ensure compliance and prevent payer denials.Delivering and explaining legally required notices, and escalating avoidable days to minimize financial loss.Assessing patient care and insurance coverage, ensuring adherence to regulations, and documenting clinical reviews accurately.Supporting continuous performance improvement initiatives and maintaining compliance with organizational policies. Qualifications And Skills Registered Nurse (RN) with a minimum of 3 years of clinical experience.Valid RN license (single-state or multi-state compact) and BLS certification required.Strong clinical knowledge, excellent communication, organizational skills, and proficiency in screening criteria and computer use.Ability to build trusting relationships with physicians and multidisciplinary teams, and to critically analyze clinical data. This role emphasizes direct, onsite collaboration to optimize patient care, ensure compliance, and support hospital operations.