Utilization Management RN – Care Coordination

Midwest Physicians Administrative Services, LLC dba Duly Health and Care; Highland Oaks (GA); On-site; USD 68,000 - 101,000; Full time

Benefits offered by this job

Medical, dental, vision benefits

Mental health benefit

Life and disability insurance

Tuition reimbursement (up to $5,250)

401(k) with match

Volunteer time off (40 hours)

Parental leave (up to 12 weeks)

Community impact and culture

Job summary

Duly Health and Care is seeking a Utilization Management Registered Nurse to conduct initial and concurrent reviews across inpatient, observation, SNF, and home health to ensure medically necessary and cost-effective care. The UM RN applies criteria, collaborates with physicians and care teams, and supports quality initiatives and NCQA standards.

The role requires a current RN license and 2+ years of clinical nursing experience, with CCM/ACM preferred.

Qualifications

• Bachelor's or Associate degree in Nursing from an accredited program.
• Current, unrestricted RN license.
• CCM or ACM certification preferred.

Responsibilities

• Performs initial and concurrent utilization reviews for inpatient, observation, SNF, acute rehabilitation, LTACH, home health, and other services as assigned.
• Determines medical necessity and appropriateness of care using criteria and guidelines.
• Evaluates level of care, length of stay, treatment plans, and discharge needs.
• Collaborates with providers, facilities, Medical Directors, case managers, social workers, and interdisciplinary teams.
• Maintains accurate, timely, and compliant documentation and protects member confidentiality.

Skills

Utilization management knowledge

RN license

Critical thinking

Documentation skills

Multidisciplinary teamwork

EMR: Epic/Tapestry

Education

Bachelor's Degree in Nursing

Tools

Epic/Tapestry

Job description

Duly Health and Care is seeking a Utilization Management Registered Nurse to conduct initial and concurrent reviews across inpatient, observation, SNF, and home health to ensure medically necessary and cost-effective care. The UM RN applies criteria, collaborates with physicians and care teams, and supports quality initiatives and NCQA standards.

The role requires a current RN license and 2+ years of clinical nursing experience, with CCM/ACM preferred.