RN Utilization Management Full Time

Position summary

The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management, and the UM process. Coordinates care submission relating to the process of health care utilization from the point of patient admission to discharge. Assignments may also include management of the clinical denials process in collaboration with finance team.

Processes will include arrangement and coordination of documentation for inpatient admissions with continued and extended hospital stays, and discharge review that determine medical necessity. The RN UM will complete and coordinate MCG as needed related to Observation patients including contact with insurance for authorization as needed. The RN UM ensures high quality care and efficiency of utilization available through healthcare resources, facilities, and services substantiating health plan reimbursement categories.

This role communicates with the interdisciplinary care team