Utilization Management Authorization Review Nurse

The Utilization Management Authorization Review Nurse manages inpatient and outpatient utilization by conducting thorough reviews of clinical documentation to ensure compliance with Care Guidelines and CMS regulations. This role involves processing authorizations, deferrals, and denials efficiently while issuing timely and accurate letters to support health plan guidelines. The position requires collaboration with healthcare providers and internal teams to ensure appropriate utilization of healthcare services and adherence to regulatory standards.