Onsite RN Team Lead

The role involves leading on-site Utilization Management (UM) staff to coordinate patient care across acute, chronic, and long-term stages, ensuring quality outcomes and efficient hospital throughput. Responsibilities include supervising staff, managing daily workflows, coaching, and participating in performance improvement activities. The Team Leader collaborates directly with physicians, attending bedside rounds, and conducting in-person consultations to assess medical necessity and appropriate levels of care. Key duties encompass performing concurrent reviews using established criteria (e.g., MCG), ensuring compliance with billing and regulatory standards, and delivering legally required documents such as Medicare notices. The role also involves managing denials, monitoring avoidable days, and facilitating communication between clinical and administrative teams. Qualifications include active RN licensure, strong clinical knowledge, and experience in utilization review or case management. Skills required are excellent communication, leadership, conflict resolution, and proficiency with electronic health records and UM software. The position emphasizes mentorship, staff development, and participation in quality initiatives to promote safe, efficient, and compliant patient care delivery.