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Utilization Management Registered Nurse RN at Loyola Medicine - ApplyBlast

Utilization Management Registered Nurse RN

Loyola Medicine

4 months ago

3.1 on Glassdoor

Hartford, CT

Hybrid

Full Time

Senior

0 applicants

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About this role

The Utilization Management Registered Nurse reviews medical services and treatment plans to ensure appropriate, cost-effective, and high-quality patient care. Collaborating with providers and care teams, the RN validates care levels using clinical guidelines while managing admission authorizations and insurance appeals.

Responsibilities

Conduct concurrent utilization reviews to validate appropriate care levels
Manage admission authorizations and payer communications effectively
Review insurance denials and support appeals processes
Collaborate with interdisciplinary teams to optimize care plans
Ensure clinical documentation reflects medical necessity

Skills

Qualifications

BSN in NursingRegistered Nurse License

About Loyola Medicine

loyolamedicine.org

Headquarters

Maywood, Illinois, United States

Company Size

5001-10000 employees

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Loyola Medicine is a not-for-profit health system providing comprehensive medical care across its hospitals and outpatient facilities in Illinois, including Loyola University Medical Center, Gottlieb Memorial Hospital, and MacNeal Hospital. The organization offers urgent and specialty care, telehealth visits, online scheduling, patient portal access (MyChart), and streamlined access to medical records and billing.