Utilization Review RN

The Utilization Review RN supports Utilization Management functions by making clinical recommendations for medical necessity, screening patients against insurance and regulatory guidelines, and coordinating care with interdisciplinary teams. This role involves conducting admission and concurrent reviews, communicating with payors and physicians, and ensuring optimal healthcare outcomes through effective resource management. The position requires maintaining confidentiality, participating in regulatory education, and advocating for patient needs while adhering to organizational policies and standards.