Utilization Management RN: Drive Efficient Care & Discharge

Liberty Health; Raleigh (NC); On-site; USD 75,000 - 110,000; Full time

Job summary

Liberty Health is seeking an experienced Utilization Management RN to oversee day-to-day UM queues, dashboards, and member care coordination in a hospital or health plan setting.

The role focuses on timely authorizations, discharge planning, and adherence to medical necessity guidelines to ensure high-quality, cost-effective care. Strong communication and problem-solving skills are essential.

Qualifications

• Licensed RN with 3–5 years of clinical experience and active license.
• 1–5 years managed care utilization management experience, preferably with a health plan.
• Experience with Medicare Advantage and utilization management criteria (InterQual/MCG) required.

Responsibilities

• Manage UM queues, dashboards, and member care coordination.
• Ensure timely authorizations and discharge planning per policies.
• Monitor medical necessity guidelines and report to leadership.
• Assist with UM reports for executive review.
• Participate in on-call rotation and occasional after-hours work.

Skills

RN license

UM management

Medicare Advantage

InterQual/MCG criteria

Communication skills

Detail-oriented

Problem-solving

Education

Registered Nurse license

Tools

InterQual

MCG criteria

EHR systems

Job description

Liberty Health is seeking an experienced Utilization Management RN to oversee day-to-day UM queues, dashboards, and member care coordination in a hospital or health plan setting.

The role focuses on timely authorizations, discharge planning, and adherence to medical necessity guidelines to ensure high-quality, cost-effective care. Strong communication and problem-solving skills are essential.