RN UM

Job SummaryPosition: Registered Nurse for Utilization Management (RN UM)MediBril is currently seeking a detail-oriented Registered Nurse for Utilization Management (RN UM) to join our team. The ideal candidate will bring a strong background in clinical nursing along with a thorough understanding of healthcare services and utilization processes. This role will involve coordinating the appropriate use of healthcare resources and ensuring quality patient care within the framework of cost management.Duties:Review and assess medical records, consults, and diagnostics to evaluate the clinical appropriateness of hospital admissions, surgeries, and other medical procedures.Engage in case reviews with healthcare providers, care teams, and insurance companies to determine the necessity and duration of medical treatments.Implement and coordinate the clinical aspects of the case management plan, including care coordination, authorization, and referral control.Provide clinical guidance to members and their families for informed medical decisions.Work closely with healthcare providers to coordinate effective care plans that meet patient needs while controlling healthcare costs.Conduct pre-certification, continued stay review, care coordination, and discharge planning.Monitor patient outcomes and make recommendations for improvement in care plans. Qualifications:A degree in Nursing from an accredited institution.Active RN license in the state of practice.Previous experience in Utilization Management, Case Management, or related field.Exceptional analytical, organizational, and communication skills.Strong clinical knowledge with the ability to interpret and analyze medical records.Knowledge of medical coding, medical terminology, and healthcare laws/regulations. What We Offer:Competitive salary and performance bonuses.Comprehensive benefits package, including healthcare, dental, and retirement plans.Professional growth and development opportunities.A collaborative and supportive work environment.