Utilization Review Nurse RN

Conduct initial, concurrent, and retrospective chart reviews to assess clinical, financial, and resource utilization data. Apply utilization review criteria to medical records, enter reviews into software, and coordinate with external payers and internal staff to prevent payment denials. Monitor utilization trends, identify denial patterns, and collaborate with care managers to expedite appeals and resolve payer issues. Document all actions taken to optimize patient outcomes and reduce length of stay. Assist in communicating discharge plans and issuing Medicare forms to patients and families. Join LifeBridge Health to advance health access and contribute to a system redefining care delivery across the mid-Atlantic.