Utilization Management (UM) Nurse

Apply critical thinking and evidence-based clinical criteria to evaluate inpatient and outpatient services requiring precertification. Conduct clinical reviews via phone and electronic documentation, collaborating with healthcare providers to gather necessary information. Use established guidelines to authorize services or escalate to Medical Directors as needed. Navigate multiple computer systems efficiently while maintaining accurate documentation. Thrive in a fast-paced, high-volume environment with strong organizational, multitasking, and prioritization skills. Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM departmental teams as needed, ensuring continuity of care and operational support. Participate in occasional on-call rotations, including some weekends and holidays, per URAC and client requirements.