RN Utilization Management Specialist

Selectminds; Port Huron (MI); On-site; USD 75,000 - 105,000; Full time

Job summary

McLaren Health Care, headquartered in Grand Blanc, Michigan, is seeking a registered nurse to join the Utilization Management team. You will assess patient status, collaborate with clinicians, and ensure medical necessity supports hospital admissions and continued stay.

Responsibilities include performing concurrent and retrospective reviews, documenting in EMR, and supporting discharge planning with the interdisciplinary team.

Qualifications

• RN licensure required.
• BSN from an accredited program.
• Three years of acute care nursing or utilization management experience.

Responsibilities

• Determine appropriate patient status and hospital admission decision based on medical necessity.
• Perform concurrent and retrospective utilization management reviews.
• Document in EMR including clinical reviews, payer authorizations and discharge planning.
• Collaborate with providers to optimize hospital reimbursement and patient care.
• Participate in clinical case reviews with the interdisciplinary team.

Skills

RN licensure

Utilization management

Interdisciplinary collaboration

Education

Bachelor of Science in Nursing (BSN)

Tools

Veracity

Optum

InterQual

Milliman

Job description

McLaren Health Care, headquartered in Grand Blanc, Michigan, is seeking a registered nurse to join the Utilization Management team. You will assess patient status, collaborate with clinicians, and ensure medical necessity supports hospital admissions and continued stay.

Responsibilities include performing concurrent and retrospective reviews, documenting in EMR, and supporting discharge planning with the interdisciplinary team.