The Utilization Management (UM) Nurse is responsible for conducting medical necessity reviews up to 12 hours per day, on any of the 7 days per week, utilizing Indicia for Case Management, and performs clinical reviews through document review, discussion with physicians and collaboration with the care team on the coordination of safe transitions of care for a defined patient population. The UM Nurse communicates with third party payors to resolve discrepancies prior to billing, accurately and concisely documents all communications regarding and actions taken on the account in accordance with policies and procedures, and escalates medical review request and/or denial activities to management as needed.