Concurrent Utilization Review (UR) Nurse

At Largeton Group, we're passionate about empowering businesses to reach new heights through innovative staffing solutions and cutting-edge technology. For over a decade, we've been dedicated to delivering exceptional service and driving growth for our clients.

Conducts real-time reviews of inpatient and skilled nursing services to assess medical necessity and appropriateness based on established clinical guidelines (InterQual, MCG). Evaluates clinical documentation for admission, continued stay, and discharge planning decisions. Coordinates with healthcare providers, payers, and interdisciplinary teams to facilitate appropriate care and seamless care transitions. Escalates complex or borderline cases to the Medical Director and collaborates on treatment recommendations and care decisions. Processes authorization requests and communicates timely approvals or denials per health plan guidelines and benefit structures. Ensures compliance with state/federal regulations, accreditation standards, and health plan policies. Maintains accurate, up-to-date documentation of reviews, authorizations, denials, and escalations. Educates providers and staff on clinical guidelines, medical necessity criteria, and authorization processes. Supports quality improvement initiatives by tracking utilization trends and identifying opportunities for resource optimization.