Utilization Management Nurse I: Clinical Review Lead

CHRISTUS Health; Shreveport (LA); On-site; USD 65,000 - 90,000; Full time

Job summary

CHRISTUS Health in Shreveport, LA seeks a Utilization Management Nurse I to determine clinical appropriateness of care, and perform pre-admission, concurrent, and retrospective UM reviews to ensure proper hospital resource utilization.

You will utilize InterQual/MCG criteria, coordinate with physicians and payors, and support documentation for medical necessity while staying compliant with CMS and Joint Commission guidelines.

Qualifications

• Graduate of an accredited school of nursing required.
• Minimum 2 years in acute clinical practice as a nurse.
• Case Management and Utilization Review experience preferred.
• Familiarity with InterQual/MCG criteria preferred.

Responsibilities

• Assess medical necessity, level of care, and appropriateness.
• Utilize InterQual/MCG criteria to support decisions.
• Coordinate with physicians and payors for approvals.
• Maintain compliance with HIPAA and regulatory guidelines.

Skills

InterQual/MCG

Communication

Multitasking

Teamwork

Regulatory knowledge

Education

RN license

BSN

Job description

CHRISTUS Health in Shreveport, LA seeks a Utilization Management Nurse I to determine clinical appropriateness of care, and perform pre-admission, concurrent, and retrospective UM reviews to ensure proper hospital resource utilization.

You will utilize InterQual/MCG criteria, coordinate with physicians and payors, and support documentation for medical necessity while staying compliant with CMS and Joint Commission guidelines.