Case Manager - Utilization Rvw

NKC Health; Kansas City, Northern (MO, KY); Hybrid; USD 70,000 - 95,000; Full time

Job summary

NKC Health is seeking an UR/denials nurse to perform chart reviews to confirm medical necessity, admission appropriateness, and level of care using clinical data and criteria. The role also supports denial management activities.

The ideal candidate has 2–3 years of case management experience, Missouri RN license, and a preferred CCM certification. Strong communication and organizational skills are essential for success in this position.

Qualifications

• RN license in Missouri is required.
• Bachelor's degree in Nursing is required.
• CCM certification preferred.

Skills

Computer Proficiency

Communication skills

Interpersonal skills

Organizational skills

Presentation skills

Education

Bachelor's - Nursing

Job description

Summary

SUMMARY: The UR/denials nurse conducts chart reviews to ensure medical necessity, appropriateness of admission, continued length of stay and level of care using clinical information and clinical criteria. The role also participates in the denial management process as well.

EXPERIENCE:

Minimum 2-3 years experience in Case Management or related healthcare field

SPECIAL SKILLS:

Computer Proficiency

OTHER:

Excellent communication, interpersonal, organizational and presentation skills

LICENSE/CERT:

Required: RN (Registered Nurse) State of Missouri Preferred: CCM (Certified Case Management)

EDUCATION:

Required: Bachelors - Nursing