RN Utilization Review Specialist – Behavioral Health

McLaren Health Care; Bay City (MI); On-site; USD 60,000 - 90,000; Part time

Benefits offered by this job

Per diem schedule

Job summary

McLaren Health Care is seeking an RN Utilization Review Specialist in Michigan for a Per Diem, on-site role in Behavioral Health. You will work with admitting physicians and care teams to determine admission status, ensure medical necessity, and optimize hospital reimbursement through concurrent reviews.

The position requires MI RN licensure and prior utilization management experience, with opportunities to contribute to process improvements and staff training while supporting timely patient

Qualifications

• Active Michigan RN license required.
• Two years of recent clinical or utilization management experience.
• Per Diem schedule with on-site hospital duties.

Responsibilities

• Perform concurrent and retrospective utilization reviews to ensure appropriate data tracking and reporting.
• Collaborate with care team to determine inpatient vs. outpatient settings based on medical necessity.
• Coordinate with case management to expedite patient discharge and optimize reimbursement.
• Maintain knowledge of UR processes and assist with compliance, audits, and denials.
• Provide training and competency development for staff and colleagues as needed.
• Analyze and improve UR operations; stay current with regulations and guidelines.

Skills

RN

Utilization management

Concurrent reviews

Documentation

Education

Registered Nurse license (MI)

Bachelor’s degree in nursing

Tools

EMR / EHR systems

Job description

McLaren Health Care is seeking an RN Utilization Review Specialist in Michigan for a Per Diem, on-site role in Behavioral Health. You will work with admitting physicians and care teams to determine admission status, ensure medical necessity, and optimize hospital reimbursement through concurrent reviews.

The position requires MI RN licensure and prior utilization management experience, with opportunities to contribute to process improvements and staff training while supporting timely patient