RN Utilization Review Specialist - Case Management

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

Benefits offered by this job

Competitive salary and performance‑based incentives

Comprehensive health, dental, and vision insurance

Retirement savings plan with employer matching

Vacation time and holiday pay

Supportive and inclusive work environment

Job summary

Gateway Regional Medical Center, Inc. is seeking a full-time Utilization Review Specialist RN responsible for conducting admission and concurrent reviews to avoid payment denials, while managing appeals. This role requires collaboration with interdisciplinary teams to enhance patient outcomes and promote efficient resource utilization.

Candidates must have five years of nursing experience in an acute care setting, current nursing license, and knowledge of relevant criteria is preferred. The position offers a competitive salary, health benefits, and a supportive work environment.

Qualifications

• Minimum of five years of clinical nursing experience in an acute care setting required.
• Current Illinois Nursing License is mandatory.
• Experience in case management, utilization review, or appeals management preferred.

Responsibilities

• Conduct admission and concurrent reviews to prevent denials.
• Coordinate and manage appeals for accounts worthy of reconsideration.
• Promote compliance with payer, regulatory, and accreditation standards.

Skills

Clinical nursing experience

Knowledge of InterQual and/or Milliman criteria

Education

Graduate of an Accredited School of Professional Nursing

Tools

Basic Life Support (AHA or American Red Cross BLS)

Job description

Gateway Regional Medical Center, Inc. is seeking a full-time Utilization Review Specialist RN responsible for conducting admission and concurrent reviews to avoid payment denials, while managing appeals. This role requires collaboration with interdisciplinary teams to enhance patient outcomes and promote efficient resource utilization.

Candidates must have five years of nursing experience in an acute care setting, current nursing license, and knowledge of relevant criteria is preferred. The position offers a competitive salary, health benefits, and a supportive work environment.