Utilization Review Care Manager - Registered Nurse/RN

A Utilization Review Nurse evaluates patient admission appropriateness using clinical data and InterQual guidelines to coordinate medical services and benefits. The role involves collaborating with physicians, payers, and care managers to manage denials, appeals, and discharge planning while ensuring compliance with managed care principles. This position requires negotiating care levels with insurers and developing comprehensive care transition plans to improve patient outcomes and reduce avoidable readmissions.