Georgia Licensed Utilization Management RN

A company is looking for an RN Central Utilization Management.

Key Responsibilities

Conduct medical necessity reviews and clinical assessments for patient admissions and ongoing care

Ensure timely authorization of hospital admissions and days, and monitor compliance with payer regulations

Document clinical reviews and maintain accurate patient records to facilitate billing and care transitions

Required Qualifications, Training, and Education

Graduate of an accredited / approved school of nursing

Bachelor's Degree in nursing (BSN) preferred

Registered Nurse (Single State) and RN - Multi-state Compact required

Minimum of 3 years of strong clinical knowledge and experience required

Knowledge of Case Management processes and screening criteria for clinical data review