Martin’s Point Health Care

Perform in-depth financial analyses, including ROI and business case evaluations, to support strategic organizational decisions. Collaborate with leadership to develop forecasting tools and monitor monthly financial performance to drive margin improvements.

The Utilization Review Nurse is responsible for reviewing prior authorization requests and performing medical necessity reviews for inpatient and outpatient services. They coordinate transitions of care, establish discharge plans, and collaborate with healthcare providers to ensure cost-efficient medical outcomes.

The Utilization Review Nurse is responsible for conducting prior authorization, concurrent, and retrospective reviews to ensure cost-efficient medical outcomes. They coordinate transitions of care, manage claims disputes, and collaborate with providers to ensure members receive the appropriate level of care.

The Utilization Review Nurse ensures high-quality, cost-efficient medical outcomes for enrollees needing inpatient/outpatient authorizations. Responsibilities include reviewing prior authorization requests, coordinating transitions of care, and managing health care within compliance regulations.