Utilization Care Manager - RN

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Scope/Position Summary
The Utilization Care Manager (UCM) contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines to determine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMS guidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payer rules, regulations and MCG guidelines. The UM CM maintains an awareness of State and National health care trends, TJC, CMS and third party payor Utilization Management guidelines.

Minimum Qualifications
For Hire: Bachelor's degree in Nursing preferred, public health, allied health, or other clinically related field. Two years of Care Management and/or Utilization Management experience required.

Final candidates are subject to successful completion of a background check. A drug screen or physical may be required during the post offer process.

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