Acute Care, Case Management, Discharge Plans, Documentation, Electronic Medical Records, Epic Systems, Healthcare, Healthcare Management, Hospital, Maintain Compliance, Medical Records, Patient Assessment, Patient Care, Patient Care Authorizations, Quality of Care, Registered Nurse (RN), Regulatory Compliance, Time Management, Utilization Management
We are seeking an experienced Registered Nurse (RN) – Utilization Review to join our healthcare team in an acute care hospital setting. The ideal candidate will be responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services while ensuring compliance with established guidelines and standards.
Key Responsibilities- Perform utilization review to assess medical necessity and appropriateness of patient care
- Conduct initial patient assessments and ongoing case evaluations
- Apply InterQual criteria to determine level of care and authorization decisions
- Collaborate with physicians, case managers, and healthcare teams to optimize patient outcomes
- Ensure accurate and timely documentation in EPIC EMR system
- Review patient records for compliance with regulatory and hospital standards
- Participate in discharge planning and care coordination as needed