Onsite RN Team Lead

The Hospital Utilization Management (UM) Nurse Team Leader oversees on-site UM staff, ensuring effective coordination during all stages of patient care. Key responsibilities include collaborating with physicians and interdisciplinary teams through face-to-face consultations, bedside rounds, and hospital huddles to assess medical necessity, optimize throughput, and determine appropriate levels of care. They perform concurrent reviews using established criteria, communicate legally required notices, and identify avoidable hospital days to prevent financial loss. Leadership duties involve staffing management, monitoring productivity and denial ratios, supervising staff, and providing mentorship and training. They participate in performance improvement initiatives, manage quality assurance activities, and support ongoing staff development. Qualifications include current RN licensure, knowledge of utilization review processes, and familiarity with insurance coverage, regulatory compliance, and clinical documentation. Skills required are strong clinical judgment, communication, conflict resolution, and leadership abilities. The role demands real-time, face-to-face interaction with healthcare providers and patients to ensure efficient resource utilization and adherence to policies, ultimately supporting safe, high-quality patient care.