Utilization Management Nurse - LTACH Care & Denials

NYC Health + Hospitals; New York (NY); On-site; USD 85,000 - 115,000; Full time

Job summary

NYC Health + Hospitals Carter seeks a Registered Nurse to perform Utilization Management within LTACH settings. You will review records, determine medical necessity, and coordinate care with providers and payers.

Role requires NY RN license and BLS, with 3–5 years bedside experience and 1–3 years in utilization review. Strong communication and EPIC proficiency are essential for successful patient transitions and approvals.

Qualifications

• Valid New York State RN license and registration.
• Current Basic Life Support (BLS) certification.
• 3–5 years in clinical bedside roles; 1–3 years in utilization review/case management preferred.

Responsibilities

• Evaluate medical records to determine medical necessity and appropriate level of care.
• Communicate with providers, patients, and payers to secure authorizations and manage continued stays.
• Document care plans and summaries in the EPIC system for accurate discharge planning.
• Collaborate with interdisciplinary teams to optimize transitions of care and reduce avoidable hospital days.

Skills

Nursing

Utilization review

Care coordination

EPIC

Communication

Education

NY RN license

BLS certification

Tools

EPIC

Job description

NYC Health + Hospitals Carter seeks a Registered Nurse to perform Utilization Management within LTACH settings. You will review records, determine medical necessity, and coordinate care with providers and payers.

Role requires NY RN license and BLS, with 3–5 years bedside experience and 1–3 years in utilization review. Strong communication and EPIC proficiency are essential for successful patient transitions and approvals.