RN Utilization Review Nurse — Inpatient UM Specialist

Healthcare Support Staffing; Troy (MI); On-site; USD 45,460 - 50,971; Full time

Job summary

A national healthcare staffing firm seeks an experienced RN Utilization Review Nurse in Troy, MI. Responsibilities include utilization review for Medicaid and Medicare, managing authorization processes, and collaborating with healthcare teams to ensure quality care. Ideal candidates must possess an RN license and have at least two years of clinical experience. This role offers a salary between $33 – $37 per hour, Monday to Friday, in a fun, positive work environment.

Qualifications

• Must be an RN.
• Minimum one year in Utilization Review or managed care.
• Familiarity with Interqual for at least one year.
• Experience in patient facilities, rehab, or home healthcare.
• Proficiency in Microsoft Office and data entry.
• Preferably hospital nursing or case management.

Responsibilities

• Provide utilization review for Medicaid and Medicare.
• Work with Utilization Management team on medical necessity.
• Conduct daily reviews for hospitalization and authorizations.
• Handle provider appeals and assist with denial letters.
• Identify members' expected length of stay and procedures.
• Collaborate with departments for continuity of care.

Skills

Utilization Review background

Interqual experience

Microsoft Office

Data Entry

Clinical practice

Typing skills

Education

RN license

Minimum 2-4 years clinical practice

Job description

A national healthcare staffing firm seeks an experienced RN Utilization Review Nurse in Troy, MI. Responsibilities include utilization review for Medicaid and Medicare, managing authorization processes, and collaborating with healthcare teams to ensure quality care. Ideal candidates must possess an RN license and have at least two years of clinical experience. This role offers a salary between $33 – $37 per hour, Monday to Friday, in a fun, positive work environment.