Utilization Review RN Team Lead
Overview
Lead clinical and operational direction for UR nursing team ensuring accurate timely compliant medical necessity reviews. Oversee workflow quality assurance staff development and onboarding. Ensure adherence to clinical criteria regulatory requirements and client expectations.
What You'll Do7
- 1Support UR nurses in conducting admissions and continued stay reviews using InterQual and MCG criteria
- 2Oversee daily team workflow to ensure accurate review completion according to priority
- 3Audit UR nurse reviews for accuracy completeness and compliance with client processes
- 4Provide feedback coaching and performance guidance to UR nurse team
- 5Support training and onboarding of new UR nurses
- 6Assist client onboarding and facilitate communication regarding utilization management
- 7Perform additional duties as assigned by Director of Utilization Management
Requirements5
- 1Proficient in InterQual and MCG within last two years
- 2Minimum five years acute care nursing experience in hospital setting
- 3Minimum three years recent hospital-based or health plan acute utilization review experience
- 4Advanced experience with acute admission and continued stay reviews
- 5Certified Case Manager CCM ACM or CMCN or CMGT-BC certification preferred
Salary Insight
$81 - $122k per year
Location
Required Skills
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