A company is looking for a Utilization Management Nurse. Key Responsibilities Perform concurrent and retrospective reviews of facility and home health services to monitor care quality and manage patient outcomes Determine observational vs acute inpatient status as part of the hospital prior authorization process Engage with providers for proactive discharge and transition planning, and coordinate interdisciplinary approaches to support continuity of care Required Qualifications Minimum 2 years of clinical experience as an RN, LPN / LVN required Minimum 1 year of managed care or equivalent health plan experience preferred Experience in health plan utilization management and facility concurrent review discharge planning required Active unrestricted Nursing license required Experience with InterQual or MCG authorization criteria preferred
Utilization Management Nurse • Pasadena, Texas, United States