RN Utilization Management Analyst: Drive Reimbursement & Care

University of Missouri Health Care; Columbia Township (MO); On-site; USD 47,000 - 58,000; Part time

Job summary

MU Health Care is seeking a Utilization Management Analyst RN to oversee patient admissions, reviews, and ensure care is medically necessary and efficient. You will help maximize reimbursements and advocate for patients while educating staff and physicians on utilization issues.

This PRN, part-time role involves collaborating with payors and care teams, monitoring utilization criteria, and supporting policy development to improve outcomes.

Qualifications

• Missouri Board of Nursing RN license or multi-state license required.
• Two years hospital clinical experience or two years in utilization review.
• Excellent written and verbal communication; knowledge of payer guidelines.

Responsibilities

• Oversee admissions and utilization to ensure medical necessity and efficiency.
• Pre-certify and preauthorize as assigned.
• Monitor 23-hour observation and discharge appropriately when needed.
• Assist with denial/appeal processes and education for staff on utilization issues.
• Collaborate with payors and hospital teams to maximize reimbursement.

Skills

Communication skills

Payer guidelines knowledge

Education

Missouri RN license

Tools

InterQual/Milliman criteria

Job description

MU Health Care is seeking a Utilization Management Analyst RN to oversee patient admissions, reviews, and ensure care is medically necessary and efficient. You will help maximize reimbursements and advocate for patients while educating staff and physicians on utilization issues.

This PRN, part-time role involves collaborating with payors and care teams, monitoring utilization criteria, and supporting policy development to improve outcomes.