Utilization Review Nurse

The Utilization Review Nurse works behind the scenes to maximize the quality and cost efficiency of health care services by ensuring patients receive necessary care without unnecessary procedures or overlong stays. This role involves reviewing medical necessity for admissions and continued hospital stays, analyzing patient records for compliance with reimbursement policies, and collaborating with care teams to coordinate patient transitions. The position serves as a patient advocate and manages the plan of care to ensure appropriate resource utilization and efficient health care delivery.