Utilization Review Care Manager

A Utilization Review Nurse evaluates patient admission appropriateness using clinical knowledge and InterQual guidelines to coordinate medical services and benefits. The role serves as a liaison between physicians, patients, and payers regarding benefit terminations, denials, and appeals while managing care transitions and reducing avoidable hospital days. Nurses handle sensitive information, negotiate care levels with insurers, and collaborate with multidisciplinary teams to improve clinical documentation and outcomes.