RN Utilization Review Case Manager — Improve Care Quality

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

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.