RN, Utilization Management

Works collaboratively with various departments across the entire health care system to review clinical documentation, utilizing evidence based criteria to support medical necessity and appropriate level of patient care for services provided. Reports outcome trends and patterns to UM leadership to help identify educational opportunities and performance improvement initiatives across the health care continuum. Determines level of care per regulatory requirements, works with payers for authorization, conducts initial and concurrent reviews using Interqual criteria, supports discharge appeal process, and provides ongoing education for UM customers.