Care Optimization RN: Utilization Management Analyst

University of Missouri Health Care; Columbia Township (MO); Hybrid; USD 68,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement plan

Tuition assistance

Employee discounts

Job summary

MU Health Care in Missouri is seeking a Utilization Management Analyst RN to join our team. You will oversee admissions, conduct reviews, ensure medical necessity, and maximize hospital reimbursements while educating staff and physicians on utilization issues.

This hybrid role requires RN licensure in Missouri, 2 years of hospital or utilization review experience, and knowledge of payer guidelines and InterQual/Milliman criteria.

Qualifications

• Excellent written and verbal communication skills.
• Knowledge of government and private insurance payer guidelines.
• Knowledge in the application of InterQual and Milliman Criteria.

Responsibilities

• Monitor admissions and notify payors timely; ensure appropriate patient type.
• Pre-certify/preauthorize processes as assigned.
• Monitor 23-hour observation and conversion to inpatient status when appropriate.
• Assist with denial/appeal processes and document avoidable delays.
• Maintain knowledge of payer criteria and document compliance in charts.

Skills

Clear communication

Payer guidelines

InterQual/Milliman criteria

Education

Missouri RN license

Job description

MU Health Care in Missouri is seeking a Utilization Management Analyst RN to join our team. You will oversee admissions, conduct reviews, ensure medical necessity, and maximize hospital reimbursements while educating staff and physicians on utilization issues.

This hybrid role requires RN licensure in Missouri, 2 years of hospital or utilization review experience, and knowledge of payer guidelines and InterQual/Milliman criteria.