Registered Nurse (RN) - Utilization Review - PRN

Role: Utilization Management Nurse (UM) Coordinator, responsible for conducting 24/7 medical necessity reviews, obtaining authorizations, and facilitating safe transitions of care. Key Responsibilities Perform clinical reviews using established criteria (e.g., MCG, mcg Indicia) for admissions, observation, and ongoing care.Coordinate with payers, physicians, and care teams to secure timely authorizations and resolve discrepancies pre-billing.Document all review activities accurately in electronic systems like EPIC and communicate effectively with stakeholders.Monitor patient care plans, evaluate appropriateness of care, and advocate for patients outside coverage if needed.Support compliance with regulations, participate in performance improvement initiatives, and serve as a mentor or preceptor. Qualifications & Skills Minimum of 3 years clinical practice experience.RN license (single-state or multi-state compact) and BLS certification required.Strong knowledge of case management, clinical criteria, and documentation standards.Excellent verbal and written communication, organizational, and critical thinking skills.Proficient in clinical data review, utilizing screening criteria, and computer systems. Additional Info: This PRN role involves working various shifts, including holidays, with responsibilities centered on clinical review, documentation, and collaboration to ensure appropriate care and billing processes.