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Supplemental UM RN - Community Health Choice
Job Profile JOB SUMMARY: The UM RN performs utilization review of Community members requiring authorization for health services. The UM RN helps ensure proper data entry of authorization in the managed care platform, and initiate the approval process for requested services/treatments utilizing nationally recognized evidenced based clinical criteria and/or internal policy?s, protocols, and procedures. This position screens and reviews clinical information for the most appropriate service areas within Community; makes referrals to high risk perinatal team, complex case management and disease management. The UM RN works closely with the Medical Directors and refers requests that do not meet medical necessity criteria. The UM RN has heavy telepho
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