RN Utilization Review

The Utilization Management Registered Nurse (RN) has well-developed knowledge and skills in areas of utilization management, medical necessity and patient status determination. The UM RN supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. The UM RN is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated and reported.