Utilization Management RN

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges. Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it. That’s Impresiv!

We are seeking an experienced Utilization Management Registered Nurse (UM RN) to support both inpatient and outpatient utilization review functions for a healthcare organization. The ideal candidate will have a strong clinical background, comprehensive UM experience across care settings, and be comfortable working independently in a remote environment.

Perform clinical review of inpatient and outpatient services to determine medical necessity, appropriateness, and efficiency of healthcare services. Apply evidence-based guidelines and UM criteria (e.g., InterQual, MCG) to make determinations. Collaborate with providers, case managers, and internal departments to coordinate care and ensure timely service delivery. Document and maintain accurate, comprehensive notes in accordance with regulatory and organizational requirements. Participate in interdisciplinary team discussions to support care planning and resource utilization.