Registered Nurse - Utilization Review - Acute Care PT Weekends

The Utilization Management (UM) Nurse is responsible for conducting medical necessity reviews, utilizing clinical criteria and documentation to determine appropriate levels of care, and coordinating safe patient transitions. They perform daily reviews of new admissions, observation cases, and concurrent care, collaborating with physicians and care teams to optimize healthcare services and ensure timely discharge planning. Key duties include obtaining authorizations, monitoring post-discharge accounts, resolving billing discrepancies, and maintaining accurate documentation within EPIC. The role requires minimum 3 years of clinical experience, RN licensure (single or multi-state), strong knowledge of case management processes, excellent communication, organizational skills, and proficiency with screening criteria and clinical documentation. They must also ensure compliance with payer and regulatory requirements, support quality improvement initiatives, and serve as a mentor for staff and students. Qualifications include an associate or bachelor’s nursing degree, and all certifications are required upon hire.