Hybrid RN Utilization Review Specialist

Munson Healthcare Careers; Traverse City (MI); Hybrid; USD 75,000 - 95,000; Full time

Benefits offered by this job

Tuition reimbursement

Full benefits

Generous PTO

Employee discounts

Free retirement counseling

Wellness platform

Improvement huddles participation

Job summary

The Utilization Review Specialist (RN) at Munson Healthcare will ensure appropriate utilization across the continuum of care, evaluating admissions, continued stays, and transitions to meet regulatory and payer guidelines. This role collaborates with physicians, case managers, and interdisciplinary teams to promote quality, cost-effective care and proper reimbursement.

Typical schedule is Mon-Fri with evening hours and weekend rotation; 50/50 hybrid/onsite at MMC ED and Copper Ridge.

Qualifications

• Current licensure as a Registered Nurse (RN) in Michigan.
• Minimum of three years clinical experience.
• Strong clinical assessment and critical thinking.
• Effective verbal and written communication.
• Proficiency in Microsoft Office and related applications.
• Ability to independently organize workload and meet deadlines.

Responsibilities

• Review admissions for appropriate status and services.
• Apply guidelines to determine inpatient vs observation status.
• Coach physicians on appropriateness of care level.
• Document progression and notify relevant parties about denials.
• Collaborate with case managers, physicians, and payers.
• Use discharge screens to assess readiness and transitions.
• Maintain accurate data in hospital information systems.

Skills

Clinical assessment

Critical thinking

Decision-making

Verbal & written communication

Microsoft Office

EHR / Cerner knowledge

Education

Current RN license in Michigan

Tools

Cerner EHR

EMR systems

Job description

The Utilization Review Specialist (RN) at Munson Healthcare will ensure appropriate utilization across the continuum of care, evaluating admissions, continued stays, and transitions to meet regulatory and payer guidelines. This role collaborates with physicians, case managers, and interdisciplinary teams to promote quality, cost-effective care and proper reimbursement.

Typical schedule is Mon-Fri with evening hours and weekend rotation; 50/50 hybrid/onsite at MMC ED and Copper Ridge.