RN Central UM Onsite

Role Overview: An on-site Hospital Utilization Management (UM) Nurse serves as the key link between clinical teams and administrative compliance, performing real-time reviews to optimize hospital resources, patient care, and reimbursement accuracy. Responsibilities Collaborate with physicians and interdisciplinary teams through face-to-face consultations, bedside rounds, and departmental huddles to assess medical necessity and care progression.Conduct admission and concurrent medical record reviews using criteria like InterQual or MCG; evaluate patient class and appropriateness of care levels.Provide immediate input on hospital throughput, assess new admissions, and support discharge planning.Deliver and explain legally required notices, identify avoidable hospital days, and escalate issues to minimize financial loss.Ensure documentation accuracy, compliance with payer regulations, and support continuous performance improvement initiatives.Assess insurance coverage, review clinical documentation, and support denial prevention efforts.Participate in professional development, serve as a mentor, and perform other duties as assigned. Qualifications & Skills: Registered Nurse (RN) with at least 3 years of clinical experience.Associates or Bachelor's Nursing degree preferred.Certifications: RN license, BLS (or equivalent) required upon hire.Strong knowledge of case management, clinical assessment, and utilization review processes.Excellent communication, organizational, and analytical skills, with proficiency in using screening criteria and computer systems.