RN Utilization Review & Care Coordination Specialist

Harrison County Community Hospital; Bethany (MO); On-site; USD 65,000 - 90,000; Full time

Job summary

Harrison County Community Hospital located in Missouri seeks a Utilization Review Coordinator (RN) to support a comprehensive review system, ensure regulatory compliance, promote efficient resource use, and enhance patient care.

The role requires 2+ years of nursing experience, MO RN licensure, and familiarity with utilization review or case management. You will educate staff, prepare reports, and assist with discharge planning and policy development.

Qualifications

• Associate or Bachelor’s degree in Nursing (ASN or BSN) required.
• Current RN license in Missouri or ability to obtain.
• Certification in Utilization Review or Case Management (ACM/CCM) preferred but not required.
• Minimum 2 years of clinical nursing experience in a hospital setting.
• Experience in utilization review, case management, or quality improvement preferred.

Responsibilities

• Conduct concurrent and retrospective reviews of patient records for appropriate utilization.
• Evaluate medical necessity, length of stay, and level of care with providers and payers.
• Identify opportunities to improve care delivery and implement quality improvement strategies.
• Review and verify documentation for accuracy and regulatory compliance.
• Collaborate with multidisciplinary teams to address discharge barriers.
• Educate staff on utilization review processes and documentation standards.
• Prepare and submit required reports for internal and external reviews and audits.
• Participate in quality improvement initiatives and policy development.
• Maintain knowledge of state and federal regulations and payer requirements.
• Serve as liaison between hospital, patients, families, and third-party payers.

Skills

Analytical skills

Problem-solving

Excellent communication

Attention to detail

Privacy/compliance awareness

EHR proficiency

Education

ASN/BSN in Nursing

Tools

EHR systems

Job description

Harrison County Community Hospital located in Missouri seeks a Utilization Review Coordinator (RN) to support a comprehensive review system, ensure regulatory compliance, promote efficient resource use, and enhance patient care.

The role requires 2+ years of nursing experience, MO RN licensure, and familiarity with utilization review or case management. You will educate staff, prepare reports, and assist with discharge planning and policy development.