Career Center

The Utilization Management RN (UM RN) utilizes professional nursing and critical thinking skills to assess patients for a clinically appropriate level of care and concurrent mitigation of denials. The UM RN maintains a strong knowledge base of evidence based clinical criteria, and federal, state UR requirements, and adeptly identifies pertinent clinical information that will support admission and continued stay hospitalization. The UM RN collaborates with other CM team members to evaluate opportunities to optimize utilization and secure payer approvals across populations of patients to meet organizational strategic objectives. Provides timely and thorough clinical information to insurance companies and other intermediaries to secure payer authorizations and avoid denial