RN Utilization Management Coordinator - Day Shift (Mon-Fri)

Corewell Health; Southfield (MI); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Comprehensive benefits

On-demand pay

Discounts directory

Identity protection

Retirement options

Job summary

Corewell Health Southfield Center in Michigan seeks a full-time Utilization Review RN to manage UR activities, including certification, recertification, and concurrent reviews. You will work with physicians to ensure appropriate levels of care and coordinate appeals with payers.

The role requires an Associate's or technical degree (Bachelor's preferred), 2 years in a clinical setting, and MI RN licensure. On-site, day shift, 40 hours/week with standard benefits.

Qualifications

• Associate's degree required (or technical degree) in a related field.
• Bachelor's degree in nursing or related field preferred.
• 2 years of relevant clinical/hospital experience.
• Hospital utilization review/UM experience preferred.
• Clinical appeals experience preferred.
• RN license in Michigan at hire.

Responsibilities

• Conduct timely utilization reviews using organization-approved UR criteria.
• Coordinate certification, recertification, and concurrent appeals processes.
• Ensure timely payer communication with adequate documentation.
• Collaborate with physician advisors and medical staff to ensure appropriate level of care.
• Refer cases for 2nd level medical necessity review as needed.
• Maintain and monitor UR-related documentation and queues in the EMR.
• Schedule follow-up reviews per policy and payer requests.

Education

Associates degree or technical degree

Bachelor's degree in nursing or related field

Job description

Corewell Health Southfield Center in Michigan seeks a full-time Utilization Review RN to manage UR activities, including certification, recertification, and concurrent reviews. You will work with physicians to ensure appropriate levels of care and coordinate appeals with payers.

The role requires an Associate's or technical degree (Bachelor's preferred), 2 years in a clinical setting, and MI RN licensure. On-site, day shift, 40 hours/week with standard benefits.