RN-Utilization Review

St. Francis-Emory Healthcare; Columbus (GA); On-site; USD 75,000 - 110,000; Full time

Job summary

The Bradley Center, part of St. Francis-Emory Healthcare in Columbus, GA, seeks an Utilization Review Registered Nurse to monitor hospital admissions and ensure appropriate use of services. You will perform pre-certification, concurrent review, and discharge planning as a liaison for safe, timely care.

Requires RN licensure, strong clinical assessment, and knowledge of utilization review processes. Prior psychiatric experience is preferred; strong documentation and coordination with care teams

Qualifications

• RN with accreditation and state licensure.

Responsibilities

• Monitor adherence to the utilization review plan.

Skills

Clinical assessment

Medical records interpretation

Utilization review knowledge

Discharge planning coordination

Interdisciplinary communication

Documentation & confidentiality

Education

Postsecondary nursing diploma/certificate

Bachelor’s degree in nursing (preferred)

Tools

Health information systems

Job description

Description

Become part of

Description

Become part of The Bradley Center, the psychiatric and behavioral health arm of the St. Francis - Emory Healthcare in Columbus, GA. As a dedicated mental health hospital, The Bradley Center complements St. Francis’s acute care offerings and shares in the system’s recognized commitment to quality, patient safety, and community trust. With the backing of a hospital network that earns multiple honors and accreditations, The Bradley Center is uniquely positioned to deliver specialized, compassionate psychiatric care in support of our region’s holistic well-being

Job Summary

• Under the supervision of the Performance Improvement/Utilization Review Manager, the Utilization Review Registered Nurse monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, admissions, and extended stays. The RN performs pre-certification, concurrent review, and discharge planning in accordance with applicable guidelines and acts as a liaison to support safe, timely, and medically necessary care.

Essential Functions

• Ensures the medical necessity and appropriateness of all hospital admissions per established criteria
• Performs concurrent medical record reviews to justify continued stay and documents appropriately
• Coordinates with care team to facilitate timely and effective discharge planning
• Communicates with third-party payers and managed care entities to provide required documentation
• Collaborates with social services and case management to streamline patient transitions and reduce readmissions
• Reviews and monitors patient charts in alignment with medical staff performance improvement metrics
• Contributes to organizational quality goals and achieves performance targets in a timely manner

Knowledge/Skills/Abilities/Expectations

• Strong clinical assessment and critical thinking skills.
• Ability to interpret medical records, criteria, and regulations.
• Knowledge of utilization review processes, discharge planning, and payer requirements.
• Proficient in communication and coordination with interdisciplinary teams.
• Skilled in documentation, confidentiality practices, and health information systems.
• Demonstrates resilience, adaptability, and the ability to manage stress effectively.

Qualifications

Education

• Postsecondary (Cert/Diploma/Program Grad) from an accredited school of nursing (Required) And
• Bachelor’s Degree in nursing (Preferred)

Licenses/Certifications

• RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of practice Upon Hire (Required) And
• BCLS - Basic Life Support Upon Hire (May be Required-Facility Specific)

Experience

• 2+ years progressive clinical experience (Preferred) And
• Prior Experience in psychiatric healthcare (Preferred)