Per Diem Utilization Review RN - Behavioral Health

McLaren Health Care; Bay City (MI); On-site; USD 55,000 - 83,000; Full time

Job summary

McLaren Health Care is seeking an RN Utilization Review Specialist to support admission decisions and ensure medical necessity. You will collaborate with physicians and the care team, conduct concurrent and retrospective reviews, and help optimize hospital reimbursement through accurate documentation and timely authorizations.

The role emphasizes nursing expertise, regulatory compliance, and process improvement within a Behavioral Health setting, with per diem scheduling and ongoing staff

Qualifications

• Nursing degree from an accredited institution.
• State of Michigan RN licensure.
• Two years of recent clinical or utilization management experience.
• Preferred: Bachelor's degree in nursing.
• Preferred: Three years in case management or utilization management.

Responsibilities

• Performs concurrent and retrospective utilization management reviews to track, evaluate, and report data.
• Collaborates with care teams to determine appropriate setting (inpatient vs outpatient) based on medical necessity.
• Works with case management to expedite patient discharge.
• Monitors utilization review processes and handles appeals, authorizations, and denials.
• Assists in measuring outcomes and implementing process improvements.
• Provides training and competency development for staff on UR operations.
• Analyzes procedures to continually improve utilization review operations.
• Stays current with regulations and advises management on required actions.
• Performs other related duties as required.

Skills

Utilization management

Documentation

Interdisciplinary collaboration

Process improvement

Education

Nursing degree

RN license (MI)

Bachelor's in Nursing (preferred)

Job description

McLaren Health Care is seeking an RN Utilization Review Specialist to support admission decisions and ensure medical necessity. You will collaborate with physicians and the care team, conduct concurrent and retrospective reviews, and help optimize hospital reimbursement through accurate documentation and timely authorizations.

The role emphasizes nursing expertise, regulatory compliance, and process improvement within a Behavioral Health setting, with per diem scheduling and ongoing staff