RN Utilization Review Case Manager

Gateway Regional Medical Center; Granite City (IL); On-site; USD 44,083 - 66,124; Full time

Benefits offered by this job

Comprehensive medical, dental, and vision insurance

Paid vacation and holiday time

Retirement plan with employer match

Stable weekday schedule (no nights or weekends)

Job summary

Gateway Regional Medical Center is looking for a Utilization Review Specialist RN to join our Case Management team in Granite City, Illinois. This full-time role is ideal for nurses eager to transition into a more analytical and administrative position, focused on service utilization and compliance.

The ideal candidate will have extensive nursing experience and a strong attention to detail, working collaboratively to ensure quality patient care. A comprehensive benefits package is offered including health insurance and competitive pay rates up to $48/hour.

Qualifications

• Minimum 5 years of acute care clinical nursing experience required.
• Experience in case management, utilization review, or appeals preferred.
• Familiarity with InterQual and/or Milliman criteria preferred.

Responsibilities

• Completing admission and concurrent chart reviews for medical necessity.
• Preventing denials from payers through timely review and documentation.
• Managing and coordinating appeals for denied or at-risk accounts.
• Collaborating with physicians and interdisciplinary teams.
• Monitoring payer requirements and regulatory compliance standards.
• Identifying denial trends to improve processes.
• Ensuring accurate documentation to support reimbursement.

Skills

Critical thinking and clinical judgment skills

Attention to detail

Problem solving

Education

Graduate of an accredited School of Nursing (RN required)

Current Illinois RN license

Current BLS certification

Job description

Utilization Review Specialist RN

Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois

Gateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.

This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process‑driven role focused on appropriate utilization of services, payer compliance, and supporting high‑quality, cost‑effective patient care.

What You'll Do

• Completing admission and concurrent chart reviews for medical necessity
• Working to prevent denials from all payers through timely review and documentation
• Managing and coordinating appeals for denied or at‑risk accounts
• Collaborating with physicians, case managers, and interdisciplinary teams
• Monitoring payer requirements and regulatory compliance standards
• Identifying denial trends and opportunities for process improvement
• Supporting efficient patient flow and appropriate level‑of‑care placement
• Ensuring accurate and timely documentation to support reimbursement

What We're Looking For

• Graduate of an accredited School of Nursing (RN required)
• Current Illinois RN license
• Current BLS certification required
• Minimum 5 years of acute care clinical nursing experience required
• Experience in case management, discharge planning, utilization review, or appeals preferred
• Familiarity with InterQual and/or Milliman criteria preferred

Ideal Candidate

• Have strong critical thinking and clinical judgment skills
• Enjoy reviewing clinical documentation and problem solving
• Are detail‑oriented and comfortable working with payer guidelines
• Thrive in a structured, policy‑driven environment
• Want to transition out of bedside nursing into a more administrative clinical role

Why Join Gateway?

• Competitive pay: $32.00–$48.00/hr
• Comprehensive medical, dental, and vision insurance
• Paid vacation and holiday time
• Retirement plan with employer match
• Stable weekday schedule (no nights or weekends, if applicable you can insert)
• Supportive case management and interdisciplinary team environment
• Opportunity to directly impact quality metrics and hospital performance

Location

Gateway Regional Medical Center
2100 Madison Ave
Granite City, IL 62040

Compensation

Compensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.

Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time – while supporting quality, compliance, and patient outcomes. Apply today.