Utilization Management RN

GENERAL SUMMARY:

Conducts day-to-day activities for the clinical, financial and utilization coordination of the patients hospital experience. Proactively consults with the interdisciplinary team which includes, but is not limited to, hospital patient care staff, physicians, patient support and family to ensure the patients hospital stay meets medical necessity and insurance authorizations are obtained in order to facilitate the patients and hospitals financial well-being.

1 year of UM experience required. 

PRINCIPAL JOB FUNCTIONS:

1. *Commits to the mission, vision, beliefs and consistently demonstrates our core values.

2. *Performs utilization review activities, including concurrent and retrospective reviews as required.

3. *Determines the medical necessity of request by performing first level reviews, using approved evidence based guidelines/criteria.

4. *Collaborates with the patients provider and other healthcare team members in m...