RN - Case Manager

Utilization Review Nurse

This position facilitates utilization management processes to ensure the right care is provided at the right place and at the right time. The Utilization Review Nurse applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization, and readiness for care transition. This role assures timely movement of patients throughout the continuum of care by conducting concurrent reviews and proactively resolving care, service, or transition of care delays or issues as necessary, in collaboration with the care team.

The position provides third-party payers with clinical information to assure reimbursement. It coordinates care with the treatment team, patients, families, and others. The role involves communication with physicians for appropriate documentation to support authorization of services.