RN Utilization Management: Optimize Care & Reimbursement

McLaren Health Care; Lansing (MI); On-site; USD 85,000 - 95,000; Full time

Job summary

McLaren Health Care in Michigan is seeking a Registered Nurse to lead utilization management activities, determine admission status, and ensure medical necessity and documentation support appropriate reimbursement.

In this full-time role, you will perform concurrent and retrospective reviews, collaborate with physicians and care teams, document in the EMR, and contribute to process improvements. Schedule is 7a–7p, 72 hours per pay period, with weekend coverage.

Qualifications

• RN license currently active in Michigan.
• Bachelor’s degree in nursing or actively pursuing degree with intent to obtain within five years.
• Three years of recent nursing or utilization management experience in an acute care hospital.

Responsibilities

• Determine patient status based on medical necessity and payer requirements.
• Collaborate with admitting/attending physicians and care teams to ensure appropriate level of care.
• Perform concurrent and retrospective utilization reviews and document findings in EMR.
• Facilitate peer-to-peer reviews with payers/providers and support discharge planning.
• Identify delays, monitor resource use, and report results to leadership.

Education

Bachelor’s degree in nursing

Registered Nurse license (RN)

Tools

InterQual

EMR documentation

Job description

McLaren Health Care in Michigan is seeking a Registered Nurse to lead utilization management activities, determine admission status, and ensure medical necessity and documentation support appropriate reimbursement.

In this full-time role, you will perform concurrent and retrospective reviews, collaborate with physicians and care teams, document in the EMR, and contribute to process improvements. Schedule is 7a–7p, 72 hours per pay period, with weekend coverage.