Impactful Utilization Review Nurse | Case Management Pro

CHI; Little Rock (AR); On-site; USD 47,000 - 62,000; Full time

Job summary

CHI St. Vincent in Arkansas is seeking a Utilization Review Nurse to ensure medical necessity and efficient inpatient services. You will perform concurrent and retrospective chart reviews, applying criteria to validate admissions and coordinate with payers for timely authorizations.

Collaborating with physicians and the care team, you will ensure patients receive appropriate treatment using cost-effective resources while upholding department policies and organization standards.

Qualifications

• RN with BSN required; CCM/ACM certification within 2 years of hire preferred.
• Bachelor's Degree in Nursing (BSN) required.
• Minimum of four (4) years of RN experience.
• At least three (3) years in acute care hospital setting.
• Preferred experience in Case Management, discharge planning or utilization management.

Responsibilities

• Conduct concurrent and retrospective reviews of patient charts to validate admission status.
• Coordinate with insurance payers to secure timely authorizations and prevent denials.
• Serve as liaison between clinical team and insurers to optimize reimbursement.

Skills

Registered Nurse (RN)

Education

BSN

Care Management certification (CCM/ACM)

Job description

CHI St. Vincent in Arkansas is seeking a Utilization Review Nurse to ensure medical necessity and efficient inpatient services. You will perform concurrent and retrospective chart reviews, applying criteria to validate admissions and coordinate with payers for timely authorizations.

Collaborating with physicians and the care team, you will ensure patients receive appropriate treatment using cost-effective resources while upholding department policies and organization standards.