Claims Utilization RN

The Utilization Review/Management (UR/UM) Nurse position will work in in our UR/UM department.  An overview of the work includes assessing patient care to ensure it is medically necessary, cost-effective, and compliant with clinical guidelines and regulatory requirements. Key duties include reviewing patient records and pre-certification requests, communicating with providers, and advocating for appropriate, evidence-based, and efficient patient care across the healthcare journey. The role requires strong analytical, documentation, and communication skills.