RN Utilization & Case Management Specialist

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

Job summary

North Mississippi Health Services seeks an RN Utilization Coordinator to coordinate utilization management activities, perform clinical reviews, educate care teams, and ensure regulatory compliance. You will collaborate with physician services and payers to determine appropriate care levels and ensure timely approvals.

The role requires strong nursing credentials and experience in a multidisciplinary setting with a variable schedule, primarily Monday–Friday with some weekend work.

Qualifications

• Minimum RN licensure with active state license.
• Strong organizational and written/verbal communication skills.
• Knowledge of payer sources, regulations, and cost containment.
• Ability to work independently and in a team.
• Experience coordinating utilization or case management is a plus.

Responsibilities

• Consults with physician services.
• Utilizes clinical diagnostics to facilitate status determination of inpatient, outpatient or observation.
• Coordinates final status with admitting and attending physicians.
• Performs initial and concurrent clinical reviews as indicated by payer and patient needs.
• Notifies and precertifies inpatient/outpatient services to payers.
• Facilitates peer to peer, written reconsiderations or appeals.
• Consults with patient financial services.

Skills

Nursing

Regulatory knowledge

Communication skills

Payer knowledge

Team collaboration

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Job description

North Mississippi Health Services seeks an RN Utilization Coordinator to coordinate utilization management activities, perform clinical reviews, educate care teams, and ensure regulatory compliance. You will collaborate with physician services and payers to determine appropriate care levels and ensure timely approvals.

The role requires strong nursing credentials and experience in a multidisciplinary setting with a variable schedule, primarily Monday–Friday with some weekend work.