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Marshfield Clinic Health System

Marshfield, Wisconsin

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WMCHealth

Hawthorne, New York

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WMCHealth

Hawthorne, New York

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Penn State Health

Reading, Pennsylvania

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Nemours

Pensacola, Florida

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St. Luke’s University Health Network

Bethlehem, Pennsylvania

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Remote,

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Kingston, New York

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Winter Park, Florida

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Denver Health

Denver, Colorado

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La Grange, Illinois

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Utilization Management Nurse II - Case Management
DescriptionSummary:The Utilization Management Nurse II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations


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