RN Utilization Management Clinician

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities: Perform utilization review activities, including concurrent and retrospective reviews of inpatient cases Monitor inpatient cases for compliance with contractual obligations and regulatory requirements Collaborate with care management and medical directors to facilitate discharge planning and improve care transitions Required Qualifications, Training, and Education: Active, unrestricted RN license in state of residence Nursing degree or diploma required; bachelor's degree in nursing preferred 2+ years of utilization review experience and knowledge of evidence-based guidelines Experience in managed care and discharge planning Knowledge of Medicare and Medicaid regulations is desirable

Jun 19, 2025 - 09:30

A company is looking for an Inpatient Utilization Management Clinician. Key Responsibilities: Perform utilization review activities, including concurrent and retrospective reviews of inpatient cases Monitor inpatient cases for compliance with contractual obligations and regulatory requirements Collaborate with care management and medical directors to facilitate discharge planning and improve care transitions Required Qualifications, Training, and Education: Active, unrestricted RN license in state of residence Nursing degree or diploma required; bachelor's degree in nursing preferred 2+ years of utilization review experience and knowledge of evidence-based guidelines Experience in managed care and discharge planning Knowledge of Medicare and Medicaid regulations is desirable