Utilization Management Nurse Specialist RN II

The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals while ensuring timely and accurate determinations for members and providers. This role involves conducting telephonic and onsite admission and concurrent reviews, collaborating with healthcare teams to develop successful discharge plans, and managing complex provider inquiries. The specialist also monitors inpatient admissions, handles medical record data transfers, and serves as a department resource for referral management processes.