Registered Nurse Utilization Review PRN-Case Management-PRN

Job Description

Summary:

The RN Utilization Review II is tasked with assessing the clinical appropriateness of patient care and ensuring effective hospital resource utilization. Responsibilities include conducting pre-admission, concurrent, and retrospective reviews using approved screening criteria (InterQual/MCG/CMS). The RN must manage a diverse workload in a dynamic regulatory environment and stay updated on payor and Joint Commission guidelines. Effective communication with clinical professionals and organizing patient insurance care is essential.

Requirements:

• BSN Degree or equivalent experience
• Familiarity with InterQual and MCG preferred
• 3-5 years in case management or utilization review
• RN License required
• CPR and Case Management certifications preferred

Work Schedule: PRN, Per Diem as needed