RN Utilization Review Specialist - Hospital Admissions

Brundage Group; Pensacola (FL); On-site; USD 70,000 - 95,000; Full time

Job summary

Brundage Group is seeking an experienced Utilization Review Nurse to perform admission and continued stay reviews, ensuring medical necessity, payer requirements, regulatory standards, and quality patient care in a hospital setting.

The role collaborates with physicians, case management, revenue cycle, and care teams; requires extensive acute care nursing background, UR expertise (InterQual/MCG), and strong documentation and communication skills.

Qualifications

• Graduate of an accredited school of nursing.
• BSN preferred.
• Current, unrestricted RN license.
• Minimum five (5) years of acute care nursing experience in a hospital setting.
• Minimum two (2) years of recent hospital-based utilization review experience.
• Experience with acute admission reviews and continued stay reviews.
• Certified Case Manager (CCM), ACM, CMGT-BC, or CM Certifications preferred.

Responsibilities

• Perform hospital admission reviews to determine medical necessity and appropriate patient status.
• Conduct continued stay reviews using approved clinical criteria.
• Evaluate clinical documentation for accuracy and payer/regulatory compliance.
• Apply InterQual and/or MCG criteria.
• Communicate review findings to physicians, case management staff, and leadership.
• Collaborate with Physician Advisors on complex cases.
• Assist with denial prevention activities and accurate documentation.
• Performs other duties as assigned.

Skills

EHR proficiency

Case management systems

Communication skills

Independent worker

Education

RN license

BSN preferred

5+ years acute care

2+ years UR experience

UR certifications preferred

Tools

InterQual/MCG criteria

Job description

Brundage Group is seeking an experienced Utilization Review Nurse to perform admission and continued stay reviews, ensuring medical necessity, payer requirements, regulatory standards, and quality patient care in a hospital setting.

The role collaborates with physicians, case management, revenue cycle, and care teams; requires extensive acute care nursing background, UR expertise (InterQual/MCG), and strong documentation and communication skills.