Utilization Management Registered Nurse

Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring precertification. This role involves collecting and reviewing clinical information from providers, spending the majority of the time at a desk and on the phone. The schedule may include weekends, holidays, and evening hours as Utilization Management is a 24/7 operation. Precertification nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral when needed.