Utilization Management Nurse - Full Time / Day Shift

Role Overview: An on-site Hospital Utilization Management (UM) Nurse acts as a vital link between clinical staff and administrative compliance, ensuring optimal patient care and resource utilization through face-to-face interactions. Key Responsibilities Perform admission and concurrent medical record reviews to determine appropriate patient classification (e.g., Inpatient vs. Outpatient).Collaborate with physicians and interdisciplinary teams through in-person meetings, bedside rounds, and departmental huddles to assess medical necessity and care progression.Consult on cases admitted via the Emergency Department to recommend suitable levels of care.Conduct on-site reviews using criteria like InterQual or MCG to ensure medical necessity and compliance.Provide in-person explanations of legally required notices, such as Medicare observation notices, and escalate avoidable hospital days to minimize financial losses.Support continuous improvement initiatives, ensure payer compliance, and document all activities accurately. Qualifications & Skills Registered Nurse (RN) license; BLS certification required.Minimum of 3 years of clinical experience with strong clinical knowledge.Proficiency in using clinical criteria for reviews and understanding payer regulations.Ability to collaborate effectively with physicians and interdisciplinary teams in a face-to-face setting.Strong documentation skills and commitment to compliance and quality improvement.