RN Utilization Management Specialist

MU Health Care; Columbia Township (MO); Hybrid; USD 68,000 - 100,000; Full time

Benefits offered by this job

Health insurance

Paid time off

Retirement options

Tuition assistance

Discounts on services

Job summary

MU Health Care is seeking a Utilization Management Analyst RN to oversee patient admissions, reviews, and ensure medical necessity and efficient care. The role emphasizes maximizing reimbursements while advocating for patients, educating staff and physicians on utilization issues.

The position is hybrid with on-site requirements about once per month, located in Mid-M Missouri within MU Health Care's academic health system. Bonafide nursing licensure and UR experience preferred.

Qualifications

• Missouri RN license required.
• 2 years hospital clinical or utilization review experience.
• Knowledge of government and private payer guidelines.

Responsibilities

• Monitor admissions and ensure appropriate patient type.
• Pre-certify/preauthorize as assigned.
• Monitor 23-hour observation and conversion to inpatient status.
• Assist with denial and appeal processes and document delays.
• Collaborate with payor reviewers to ensure utilization of resources.
• Provide education to staff and physicians on utilization issues.
• Maintain knowledge of payor criteria and policies.

Skills

Communication

Team collaboration

Payer guidelines

Education

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 medical necessity and efficient care. The role emphasizes maximizing reimbursements while advocating for patients, educating staff and physicians on utilization issues.

The position is hybrid with on-site requirements about once per month, located in Mid-M Missouri within MU Health Care's academic health system. Bonafide nursing licensure and UR experience preferred.