RN Utilization Review Specialist for Care Optimization

Community Memorial Hospital, Inc. in Hamilton, NY is seeking a Registered Nurse to conduct utilization reviews, determine medical necessity, and coordinate authorizations with physicians and insurers. The role requires 2–3 years of clinical nursing experience and active RN licensure. You will evaluate documentation, report utilization issues, and support quality improvement while ensuring CMS and payer compliance, with a focus on efficient, high-quality patient care.