Utilization Management RN

HJ Staffing is partnering with Impresiv Health, a specialized healthcare consulting partner, to find a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN). This critical remote position supports both inpatient and outpatient utilization review, ensuring medical necessity and appropriate use of resources. This role demands strong clinical acumen, excellent documentation skills, and a solid working knowledge of Medicare Advantage regulations.

What You Will Do:

As a UM RN, you will be responsible for applying evidence-based criteria to clinical reviews and driving seamless Transitions of Care (TOC).

• Utilization Review: Conduct clinical reviews of inpatient, outpatient, and Skilled Nursing Facility (SNF) services to assess medical necessity, appropriateness, and efficiency using evidence-b...