Job Description
DescriptionRegistered Nurse uses approved screening criteria (MCG®/CMS Inpatient
List) to determine the medical necessity of a requested hospitalization and the appropriate level of
care for that patient. Actively involved in the continued management of patient status/LOC. Provides
consultative role as utilization management nurse to clinical and non-clinical departments.
Documents objective findings against approved indicators. Assists with retrospective reviews and
medical necessity denials per communication with third party payors. Follows UR policies and
procedures and assists with continually improving the quality and effectiveness of the utilization
management program at CSVRMC.
