Nurse Registered Utilization Management

The Utilization Management Registered Nurse (UM RN) is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services in accordance with established criteria, regulatory requirements, and organizational role.

The UM RN ensures optimal patient care delivery while supporting compliance, quality outcomes, and effective resource utilization.

The role is responsible for the assessment of medcial necessity, both for admission to the hospital as well as continued stay.

This function ensurses that services are not only appropriate but ensures that an authorization is obtained from the payer, if required, and that the documentation supports the care delivered in such a way that minimzes risks of denials.