RN UTILIZATION REVIEW SPECIALIST Per Diem

The Utilization Review RN Specialist reviews and monitors utilization of health care services with the goal of maintaining high quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and inpatient stays and the utilization of ancillary services. Coordinates and conducts medical necessity reviews for all payers upon admission and concurrently throughout the admission. Interfaces with Care Management team, physicians, and payers to appeal denials and address documentation issues.