Utilization Management RN - Jefferson Health Plan

As a Utilization Management Nurse, you will expertly review clinical information for post-acute and inpatient settings to ensure cost-effective, quality patient care management. You will function as a liaison between providers and the organization, utilizing specific criteria guidelines to determine appropriate levels of care and manage admissions. This role requires reviewing medical records, identifying utilization trends, and maintaining departmental regulatory timeframes for timely decision-making while serving as a resource for various medical departments.