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Utilization Management Nurse

The Utilization management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.

Job Duties and Responsibilities:

  • Concurrent review of patient’s clinical information for efficiency
  • Ongoing review of precertification requests for medical necessity
  • Monitor the activities of clinical and non-clinical staff
  • Coordinates patient’s discharge planning needs with the healthcare team
  • Employ effective use of knowledge, critical thinking, and skills to:
    • Advocate quality care and enhanced quality of life
    • Prevent patient complications during hospital stay
    • Advocate decreased hospital stay when appropriate
  • Maintain accurate records of all patient related interactions
  • Prepare monthly patient management and cost savings report
  • Work in an intensive, fast-paced environment with minimal supervision
  • Ability to stay organized and interact well with others in any situation
  • Provide daily updates to Manager of Utilization Management for review


Skills and Qualifications:

  • Bachelor’s degree in Nursing
  • State licensure as a Registered Nurse (RN)
  • Minimum 2 years of prior experience in Utilization Management
  • Strong knowledge of word processing and spreadsheet computer programs
  • Utilization Management or Case Management certification preferred
  • Basic Life Support certification preferred. Must obtain within 60 days of hire if not currently certified.

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