RN-Utilization Management and Denials Liaison

RN Utilization Management and Denials Liaison coordinating UM initiatives across regional clinical and operational teams, physician liaisons, and revenue cycle leadership. Performs audits on UM denial write-off accounts to categorize root causes and identify opportunities for claims re-bill. Maintains UM payer grids with contractual requirements, stays current on state and federal UM regulatory requirements, represents the system UM team on committees, presents complex information to UM leadership, and collaborates with teams to improve UM outcomes. Applies evidence-based nursing practice to patient care per department scope and provides resources and education to improve UM results. Requires RN licensure in applicable states and ongoing clinical/UM experience.