RN Utilization Management Specialist

Summa Health System is seeking a Full-Time Utilization Management Nurse to optimize cost-effective care across the hospital care continuum. The role involves performing initial and concurrent reviews, aligning with Medicare/ payer guidelines, and applying clinical criteria to determine appropriate inpatient vs.

observation status. Responsibilities include collaborating with the Transitional Care Team and physician advisors, ensuring compliant discharge appeals, and supporting denial review