Job Description: Use your clinical background to coordinate, document, and communicate all aspects of the utilization and benefit management process Ensure members receive the most appropriate level of care while meeting state and federal requirements and turnaround times Review clinical documentation, collaborating with providers, and supporting high-quality, cost‑effective care Review services for medical necessity and appropriate benefit use Facilitate efficient discharge planning Collaborate with providers and facilities to support members with complex needs Collect and evaluate clinical information, applying clinical criteria, guidelines, policies, and judgment to make coverage determinations Communicate with providers and external partners to coordinate care and treatment plans Identify opportunities for referrals to additional programs, services, or care solutions Recognize opportunities to promote quality care delivery and effective benefit utilization Serve as a resource to internal and external stakeholders regarding UM processes and clinical considerations Requirements: Active, unrestricted RN license 2+ years of acute hospital clinical experience (strong preference for medical‑surgical, ICU, behavioral health or other specialty area) Strong clinical assessment and decision‑making abilities Excellent organizational skills with the ability to manage multiple priorities Ability to work independently and communicate effectively via phone Comfort with computer-based work, multitasking across multiple screens, and documenting while on calls 1+ year of Utilization Review experience (preferred) 1+ year of Managed Care experience (preferred) Proficiency in Microsoft Office (Word, Excel, PowerPoint, Outlook) (preferred) Strong telephonic communication skills (preferred) Benefits: medical, dental, and vision coverage paid time off retirement savings options wellness programs comprehensive benefits package