Utilization Management Nurse

Job Description Job Description Duties: Utilization Management: Conducts and monitors clinical review cases to ensure medical necessity of inpatient and outpatient services, diagnostic procedures, out-of-network services, and surgery; documenting all relevant and specific information; and screens, prioritizes and organizes determination requests according to mandates and standards.

Promotes appropriate care and quality toward cost effective and cost containment measures based on evidence.

Commu…