RN, Inpatient Utilization Management Specialist

Integrated Resources Inc.; Troy (MI); On-site; USD 75,000 - 95,000; Full time

Job summary

A leading staffing firm is seeking a Utilization Management professional who is responsible for inpatient medical necessity and utilization review. The ideal candidate will have an RN license, strong problem-solving skills, and at least 4 years of clinical nursing experience, preferably in the healthcare utilization sector. Keys to this role include assessing care needs, ensuring compliance with regulations, and maintaining effective relationships with providers and members.

Qualifications

• Minimum 4+ years of clinical practice, preferably in hospital nursing.
• Experience with Medicaid and Medicare denial letters.
• Knowledge of InterQual and MCG criteria.

Responsibilities

• Conducts daily review and evaluation of members requiring hospitalization.
• Provides prior authorizations and concurrent review as part of the Utilization Management team.
• Maintains productivity and quality measures within the department.

Skills

Communication

Problem Solving

Organizational Skills

Education

Completion of an accredited Registered Nursing program

Job description

A leading staffing firm is seeking a Utilization Management professional who is responsible for inpatient medical necessity and utilization review. The ideal candidate will have an RN license, strong problem-solving skills, and at least 4 years of clinical nursing experience, preferably in the healthcare utilization sector. Keys to this role include assessing care needs, ensuring compliance with regulations, and maintaining effective relationships with providers and members.