Description
Job Description Job Summary: Key Job Responsibilities The Post-Procedure Utilization Management (UM) Registered Nurse is responsible for performing real-time utilization review for surgical and procedural patients immediately following procedures. This role ensures accurate patient status determination (IP/OP/OBS), compliance with CMS and payer requirements, and timely documentation to support correct billing, regulatory adherence, and patient flow. The Post-Procedure UM RN collaborates closely with PACU staff, surgical teams, and revenue cycle partners to resolve order discrepancies, initiate status changes when appropriate, complete clinical reviews using CMS 2-Midnight, MCG, and InterQual criteria, and maintain accurate census and handoffs. This position requires strong clinical judgment, efficiency in fast-paced environments, and a proactive, collaborative communication style Qualifications Educational Requirements: Assoc. Degree/College DiplomaGraduate of an accredited nursing program Bachelor’s DegreeNursing Licenses: RN State License Basic Life Support (BLS) Experience: 3 yearsIn acute nursing 2 yearsCase Management 1 yearCPT coding Physical Demands: Lifting50 lbs. Carrying 50 lbs. Pushing75 lbs. Pulling 75 lbs.Balancing, Stooping,Kneeling,Crouching, Reaching, Handling, Grasping, Feeling, Talking, Hearing, Repetitive Motions,Eye/Hand/Foot Coordination