Hybrid RN Utilization Management Analyst (PRN)

MU Health Care; Columbia Township (MO); Hybrid; USD 35,000 - 46,000; Part time

Job summary

MU Health Care is seeking a Utilization Management Analyst RN to oversee admissions, perform concurrent reviews, and maximize reimbursement while advocating for patients. The role requires collaboration with healthcare teams and knowledge of payer guidelines to ensure medically necessary and efficient care.

The position is hybrid with PRN shifts, base pay is $36.11/hr, and involves educating staff and physicians on utilization issues at MU Health Care.

Qualifications

• Missouri RN license required; 2 years hospital clinical or utilization review experience.

Responsibilities

• Monitor unscheduled admissions to ensure appropriate patient type and notify payor.
• Pre-certify/preauthorize process as assigned.
• Monitor 23-hour observation and convert to inpatient status or discharge as appropriate.
• Assist with denial and appeal processes and document delays.
• Develop action plans for patients with extended LOS per benefit plan.
• Collaborate with payor reviewers to ensure appropriate utilization of resources.
• Provide education on utilization issues to staff and physicians.
• Maintain knowledge of payor criteria/policies and CQI activities.

Skills

Excellent written/verbal communication

Payer guidelines knowledge

InterQual/Milliman criteria

Education

Missouri Board of Nursing RN or multi-state RN licensure

Job description

MU Health Care is seeking a Utilization Management Analyst RN to oversee admissions, perform concurrent reviews, and maximize reimbursement while advocating for patients. The role requires collaboration with healthcare teams and knowledge of payer guidelines to ensure medically necessary and efficient care.

The position is hybrid with PRN shifts, base pay is $36.11/hr, and involves educating staff and physicians on utilization issues at MU Health Care.