Utilization Management RN

The Utilization Management RN evaluates the efficiency, appropriateness, and medical necessity of medical services and procedures for the Health Plan. This role utilizes clinical knowledge to review services against evidence-based criteria, authorize requested treatments, and refer questionable cases to medical directors to prevent unnecessary procedures or prolonged hospital stays. The position may involve cross-training in Case Management with potential for growth into a combined UM/CM role or a transition into Case Management.