Utilization Management RN

Description:
We are seeking an experienced Utilization Management Registered Nurse (UM RN) to support both inpatient and outpatient utilization review functions for a healthcare organization. The ideal candidate will have a strong clinical background, comprehensive UM experience across care settings, and be comfortable working independently in a remote environment.

What You Will Do:

• Perform clinical review of inpatient and outpatient services to determine medical necessity, appropriateness, and efficiency of healthcare services.
• Apply evidence-based guidelines and UM criteria (e.g., InterQual, MCG) to make determinations.
• Collaborate with providers, case managers, and internal departments to coordinate care and ensure timely service delivery.
• Document and maintain accurate, comprehensive notes in accordance with regulatory and organizational requirements.
• Participate in interdisciplinary team discussions to support care planning and resource utilization.

You Will Be Successful If:

• You have a strong understanding of both inpatient and outpatient utilization review and can confidently apply clinical criteria to support medical necessity decisions.
• You are comfortable navigating AcuityNxt and can quickly adapt to other healthcare technology platforms.
• You excel in remote work environments, managing your time effectively while meeting daily review targets and documentation standards.
• You communicate clearly and professionally with providers, peers, and interdisciplinary teams to ensure collaborative and timely care coordination.
• You are detail-oriented and committed to maintaining compliance with regulatory guidelines and internal UM policies.
• You approach each case with sound clinical judgment, balancing patient care needs with appropriate resource utilization.

What You Will Bring:

• Active, unrestricted RN license (state-specific or compact license as required).
• Minimum 3–5 years of Utilization Management experience, with a strong background in both inpatient and outpatient review.
• Experience with Medicare Advantage required. 
• Experience using AcuityNxt is highly preferred.
• Proficiency with clinical guidelines, healthcare regulations, and UM processes.
• Strong attention to detail and ability to work independently in a fully remote setting.
• Excellent communication and documentation skills.
• Prior experience in managed care, health plan, or payor environment.

About Impresiv Health:

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges.

Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.

That’s Impresiv!