Case Management & Care Coordination
Utilization Review Nurse
Reviews medical necessity of admissions and continued stays to ensure appropriate resource utilization and payer compliance.
Salary Range
$70,000 – $100,000
Education
BSN
Next Steps
Utilization Manager, Case Management Director
Key Responsibilities
- Review inpatient and outpatient records for medical necessity
- Apply InterQual or Milliman criteria
- Communicate with payers and physicians
- Identify and address denial risk
- Produce utilization reports for leadership
Work Settings
HospitalsInsurance CompaniesManaged Care Organizations
Certifications
CPURACM
Career Advancement
Utilization Manager, Case Management Director
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Case Management & Care Coordination careers