RN Coordinator-Utilization Review/Full Time/Remote

Henry Ford Health System; Troy (MI); Remote; USD 60,000 - 80,000; Full time

Job summary

A leading health system is seeking a Registered Nurse in Troy, Michigan, to oversee the quality of patient care while managing hospital resources and financial risks. The role requires a valid Michigan license and a strong clinical background, ensuring effective delivery of services through critical assessments. Candidates must have a Bachelor's degree or extensive relevant experience.

Qualifications

• Registered Nurse with valid Michigan License.
• Minimum 3-5 years clinical experience required.

Responsibilities

• Review and screen appropriateness of services and hospital resource utilization.
• Facilitate healthcare delivery in a cost-effective manner.

Skills

Critical thinking

Clinical knowledge

Regulatory knowledge

Business knowledge

Education

Bachelor of Science Nursing

4 years Case Management/Appeal/Utilization Management experience

Job description

GENERAL SUMMARY:

Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. Combines clinical, business, regulatory knowledge, and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided. Through continuous assessments from admission through discharge, problem identification and education, facilitates the quality of health care delivery in the most cost effective and efficient manner. Utilizes best practice workflows, evidence-based screening criteria and critical thinking to maximize reimbursement.

EDUCATION/EXPERIENCE REQUIRED:

• Registered Nurse required.


• Minimum 3-5 years of clinical experience required.


• Bachelor of Science Nursing required OR four (4) years Case Management/ Appeal/Utilization Management experience in lieu of bachelor's degree.

CERTIFICATIONS/LICENSURES REQUIRED:

• Registered Nurse with a valid, unrestricted State of Michigan License.

Additional Information

• Organization: Corporate Services


• Department: Central Utilization Mgt


• Shift: Day Job


• Union Code: Not Applicable