Hybrid RN: Utilization Review Specialist

Munson Healthcare; Traverse City, Northern (MI, KY); Hybrid; USD 80,000 - 100,000; Full time

Benefits offered by this job

Full benefits

Tuition reimbursement

Paid holidays

Generous PTO

Employee discounts

Free retirement counseling

Job summary

Munson Healthcare is seeking an experienced Utilization Review Specialist (RN) to ensure appropriate utilization of healthcare services across the continuum of care. You will collaborate with physicians, case managers, and payers to optimize care and reimbursement while upholding regulatory standards.

The role emphasizes strong clinical judgment, communication, and knowledge of utilization management principles, with a 50/50 hybrid onsite schedule in northern Michigan.

Qualifications

• Current licensure as a Registered Nurse (RN) in Michigan.
• Minimum of three years clinical experience.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office, Outlook, and related computer applications.
• Ability to independently organize workload, manage priorities, and meet deadlines.
• Demonstrated attention to detail and problem-solving abilities.

Responsibilities

• Reviews admissions for appropriate status and services according to patient condition.
• Applies guidelines to determine inpatient vs observation level of care.
• Coaches physicians on inpatient vs observation appropriateness.
• References physician if documentation does not support care level.
• Maintains documentation for each patient supporting care level and transitions.
• Participates in daily huddles and care conferences to monitor patient status.
• Notifies insurers of review information and flags potential denials.
• Collaborates with clinical team to confirm benefit eligibility for post-acute services.

Skills

RN license

Clinical experience

Critical thinking

Communication skills

Microsoft Office

Organizational skills

Problem-solving

Tools

Microsoft Office

Outlook

Job description

Munson Healthcare is seeking an experienced Utilization Review Specialist (RN) to ensure appropriate utilization of healthcare services across the continuum of care. You will collaborate with physicians, case managers, and payers to optimize care and reimbursement while upholding regulatory standards.

The role emphasizes strong clinical judgment, communication, and knowledge of utilization management principles, with a 50/50 hybrid onsite schedule in northern Michigan.