Per Diem RN - Utilization Management Specialist

McLaren; Michigan; On-site; USD 90,000 - 120,000; Full time

Job summary

McLaren Health Care in Michigan is seeking a Registered Nurse to lead utilization management, determining inpatient vs outpatient status and ensuring medical necessity for admission decisions.

You will perform concurrent and retrospective reviews, collaborate with the care team, request additional clinical documentation as needed, and support discharge planning and payer communications to optimize reimbursement.

Per diem schedule with 8 AM–4:30 PM hours supports flexible coverage.

Qualifications

• RN license is required to practice.
• BSN or actively pursuing degree within five years of accepting position.
• Three years of recent nursing or utilization management experience in an acute care hospital.

Responsibilities

• Performs concurrent and retrospective utilization management reviews.
• Determines inpatient vs outpatient status based on medical necessity.
• Collaborates with care teams and physicians to optimize hospital reimbursement.
• Documents medical necessity, level of care, and prior authorizations in the EMR.
• Facilitates peer-to-peer reviews with payers/providers and supports discharge planning.

Skills

RN licensure

Clinical documentation

Collaboration

Education

Bachelor’s degree in Nursing

Pursuing degree within 5 years

Tools

EMR (Electronic Medical Records)

Veracity

Optum

InterQual

Milliman

Job description

McLaren Health Care in Michigan is seeking a Registered Nurse to lead utilization management, determining inpatient vs outpatient status and ensuring medical necessity for admission decisions.

You will perform concurrent and retrospective reviews, collaborate with the care team, request additional clinical documentation as needed, and support discharge planning and payer communications to optimize reimbursement.

Per diem schedule with 8 AM–4:30 PM hours supports flexible coverage.