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Utilization Review Nurse, Case Management
Job DescriptionGeneral SummaryProvides utilization review and denials management for an assigned patient case load. This role utilizes MCG nationally recognized care guidelines/criteria to assess the patient's need for outpatient or inpatient care as well as the appropriate level of care. The role requires interfacing with the case managers, medical team, other hospital staff, physician advisors and payers.The Care Coordinator is responsible for the achievement of optimal health for the patient, access to care and appropriate utilization of resources. The patient's plan of care will be balanced with their right to self-determination and patient/caregiver choice. The Care Coordina
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