RN Central UM Onsite

Role Overview: An on-site Hospital Utilization Management (UM) Nurse serves as the vital link between clinical staff and administrative compliance, performing real-time, face-to-face interactions with physicians, patients, and interdisciplinary teams to optimize hospital resources, patient care, and reimbursement accuracy. Key Responsibilities Physician Collaboration: Meet with providers to review documentation supporting medical necessity and coordinate complex cases with physician advisors.Patient Class Decisions: Attend bedside rounds and departmental huddles to provide immediate input on care progression and admission assessments.Compliance & Documentation: Conduct concurrent medical record reviews using criteria like InterQual or MCG, deliver legally required notices, and document clinical reviews accurately and timely.Financial & Administrative Oversight: Identify and escalate avoidable days to reduce financial loss, ensure payer regulation compliance, and support performance improvement initiatives. Qualifications & Skills: Associates or Bachelor's Nursing degree; RN licensure (single or multi-state compact) with current BLS certification.Minimum 3 years of clinical experience with strong knowledge of case management and clinical review processes.Excellent verbal and written communication, organizational skills, and computer proficiency.Ability to build trusting relationships with physicians and multidisciplinary teams, analyze clinical data, and effect change for timely patient throughput. Additional Duties: Participate in professional development, serve as a mentor, and adhere to organizational policies and standards.