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Utilization Care Manager (RN)
Scope/Position SummaryThe Utilization Care Manager (UCM) contributes to the hospital's Utilization Management Program Plan by using medical necessity guidelines todetermine appropriateness for inpatient level of care or observation services based on documented clinical information in compliance with CMSguidelines and other payer requirements regarding appropriate level of care. This role requires in-depth knowledge and ability to apply various payerrules, regulations and MCG guidelines. The UM CM maintains an awareness of State and National health care trends, TJC, CMS and third party payorUtilization Management guidelines.Minimum QualificationsFor Hire: Bachelor's degree in Nursing preferred, public he
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