The Utilization Management Registered Nurse uses clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. You will report to the Manager of Utilization Management and serve as a member of the One Home/Home Solutions Utilization Management team. This team manages post-acute care services. These services include Skilled Nursing Facility (SNF), Home Health, and Durable Medical Equipment (DME). The team's goal is to ensure members receive the appropriate level of care in the most appropriate setting.
As a Utilization Management Registered Nurse:
+ You will use clinical nursing skills to interpret and support the coordination, documentation and communication of medical services and benefit administration determinations. + Using established medical criteria, you will make determinations based on information provided b...