RN Utilization & Case Management Coordinator

LE101 North Mississippi Medical Center, Inc; Mississippi; On-site; USD 65,000 - 81,000; Full time

Job summary

North Mississippi Health Services is seeking an RN Utilization Coordinator to manage utilization and case management activities. You will collaborate with physician services, perform clinical reviews, educate care teams, and ensure regulatory compliance.

The role emphasizes efficient patient status determinations for inpatient, outpatient, and observation services. Requirements include an Associate’s Degree in Nursing (RN licensed) with ACM certification preferred.

Qualifications

• Associate’s Degree in Nursing (required).
• Bachelor’s Degree in Nursing (not required).
• ACM certification and RN licensure per state requirements.
• Excellent written and verbal communication skills are essential.

Responsibilities

• Consults with physician services to coordinate care.
• Performs initial and concurrent clinical reviews for payer needs.
• Educates care team on level of care criteria and payer requirements.
• Coordinates final status with admitting and attending physicians.
• Handles precertification/notification with payers and facilitates denials/appeals.

Skills

Excellent organizational skills

Excellent written & verbal comms

Payer knowledge & regulations

Interpersonal skills

Patient population care

Independent work

Problem solving

PI involvement

Regulatory compliance

Positive attitude

Education

Associate’s Degree in Nursing

Bachelor’s Degree in Nursing

Job description

North Mississippi Health Services is seeking an RN Utilization Coordinator to manage utilization and case management activities. You will collaborate with physician services, perform clinical reviews, educate care teams, and ensure regulatory compliance.

The role emphasizes efficient patient status determinations for inpatient, outpatient, and observation services. Requirements include an Associate’s Degree in Nursing (RN licensed) with ACM certification preferred.