Registered Nurse - Utilization Management - Full Time

Job Description

POSITION SUMMARY

The RN Utilization Management Days is responsible for the overall Utilization Management process for assigned patient population. This includes reviewing clinical information to determine the appropriate level of care assignment, along with the completion and submission of reviews to insurance payers with appropriate follow-up. The RN u tilizes designated criteria/guidelines to determine and document the medical necessity and appropriate level of care. This position a nalyzes clinical information received to facilitate authorization from insurance providers, maximize reimbursement by preventing denials, and ensures clinical data is sufficient to obtain an authorization. This position ensures that the obligation for clinical review is met according...