Inpatient Utilization Management Specialist

The Inpatient Utilization Management Specialist assesses, plans, and directs utilization reviews, discharge planning, and transition of care to optimize healthcare outcomes for members. This role involves reviewing admissions and services against evidence-based clinical criteria to determine medical necessity and benefit coverage. The specialist functions as part of an interdisciplinary team, communicating with internal and external stakeholders to ensure continuity of care and accurate documentation.