Endodontist

The Utilization Management Nurse I evaluates the appropriateness of patient care and hospital resource use through pre-admission, concurrent, and retrospective reviews.

Utilizes criteria like InterQual and MCG to assess medical necessity and care levels.

Collaborates with healthcare teams and payors to ensure accurate documentation, obtain approvals, and prevent denials.

Reviews hospital status, plans surgeries, and monitors observation patients for appropriate discharge or status change.

Maintains regulatory compliance, communicates effectively, and advocates for quality patient care.

Requires nursing licensure, 2+ years acute clinical experience, and case management or utilization review background preferred.