Utilization Review RN- Care Coordination- Full Time

An RN Utilization Review specialist at Elliot Health System ensures the effective and efficient use of hospital services by conducting admission and continued stay reviews. The role involves collaborating with physicians and payer care managers to determine medical necessity, prevent claim denials, and facilitate smooth patient transitions across care settings. This position requires active clinical judgment to monitor observation status and refer cases that do not meet admission guidelines to physician advisors.