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Registered Nurse - Behavioral Health Unit - Utilization Management
Overview Performs utilization review of inpatient admissions, outpatient surgeries, and ancillary services. Performs precertification, concurrent and retrospective reviews, and coordination of discharge planning. Determines medical necessity and appropriateness of services using clinical review criteria. Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum. Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care team to maintain high quality and cost effective care delivery.Requires an Associates of Nursing (ASN).Bachelors of Nursing (BSN) preferred.Requires an active Registered Nurse (RN) license in
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