Utilization Review (RN) - Part Time (28 hours/week)

The Utilization Review RN evaluates the medical necessity and appropriateness of healthcare services using MCG criteria to ensure compliance with regulations and payer requirements. This role facilitates timely insurance pre-authorizations, confirms medical necessity, and helps prevent avoidable denials while collaborating with clinical teams and payers. The position also involves investigating denials and financial risks to optimize reimbursement and support regulatory compliance.