Utilization Review - Registered Nurse (Weekend)

The Utilization Review RN will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination.

Collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals.

Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team.

Active participation in program development and process improvement efforts is an expectation.