RN - Utilization Review & Care Coordination

Overview: Join a dedicated healthcare team as a Registered Nurse specializing in Utilization Review and Coordination of Care. This role involves evaluating patient admissions and ongoing care to ensure medical necessity and appropriate treatment levels, collaborating closely with physicians and advanced practice providers.
Responsibilities: Conduct initial and concurrent utilization reviews for admitted and observation patients, ensuring compliance with regulatory and payer requirements. Partner with interdisciplinary teams to facilitate clinical guidelines and optimize treatment outcomes in a cost-effective manner. Analyze patient records to determine admission appropriateness, treatment plans, and length of stay. Maintain up-to-date knowledge of regulatory changes affecting utilization management and perform reviews accordingly. Manage denials and appeals in collaboration with management and payors, ensuring timely responses.
Educat...