Registered Nurse - Utilization Management

About the role

The Registered Nurse – Utilization Management provides evidence‑based nursing care while ensuring compliance with utilization management (UM) criteria. The role involves reviewing patient care levels, analyzing data, and educating providers across the VA health system.

Key responsibilities

• Perform compliance reviews using UM criteria for prospective, observation, admission, and continued‑stay patients.
• Collect, analyze, and report utilization data to support clinical decision‑making.
• Create and deliver education to a variety of providers on UM processes and best practices.
• Collaborate with interdisciplinary teams to determine appropriate level of care and treatment plans.
• Conduct InterQual reviews for patient admissions and ongoing stays.

Required profile

• Proficiency in written and spoken English.
• Graduate of an ACEN‑ or CCNE‑accredited nursing program (or equivalent foreign nursing education with validated equivalency).
• Current, full, active, and unrestricted RN licensure in a U.S. state, territory, or the District of Columbia.
• Ability to obtain a state license if enrolled in a master’s‑level bridge program or to serve as a Graduate Nurse Technician on a temporary basis while pursuing licensure.

Required skills

• Utilization Management (UM) criteria application.
• InterQual review methodology.
• Data collection, analysis, and reporting.
• Provider education and training.