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(Registered Nurse) Utilization Review Coordinator/Full-Time
DescriptionRegistered Nurse uses approved screening criteria (MCG®/CMS InpatientList) to determine the medical necessity of a requested hospitalization and the appropriate level ofcare for that patient. Actively involved in the continued management of patient status/LOC. Providesconsultative role as utilization management nurse to clinical and non-clinical departments.Documents objective findings against approved indicators. Assists with retrospective reviews andmedical necessity denials per communication with third party payors. Follows UR policies andprocedures and assists with continually improving the quality and effectiveness of the utilizationmanagement program at CSVRMC.Requirements


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