RN Utilization Review Specialist (Hybrid)

Munson Healthcare; Michigan; Hybrid; USD 75,000 - 100,000; Full time

Benefits offered by this job

Full benefits

Paid holidays

Generous PTO

Employee discounts

Retirement counseling

Job summary

Munson Healthcare in northern Michigan is seeking an Utilization Review Specialist (RN) to ensure appropriate utilization of healthcare services across the continuum of care. You will evaluate admissions, continued stays, and transitions of care to align with regulatory requirements and payer guidelines.

Collaborating with physicians, case managers, and payers, you will promote high-quality, cost-effective care while supporting reimbursement and organizational performance; strong clinical

Qualifications

• Current licensure as an RN in Michigan.
• Minimum of three years clinical experience.
• Strong clinical assessment and decision-making skills.
• Proficiency with Microsoft Office and EMR systems.

Responsibilities

• Reviews admissions to determine appropriateness for inpatient or observation status.
• Monitors payer requirements and regulatory guidelines.
• Maintains documentation of care criteria supporting level of care.
• Collaborates with physicians, case managers, and payers to resolve progression-of-care barriers.

Skills

Clinical judgement

Critical thinking

Communication skills

Regulatory knowledge

Team collaboration

EHR proficiency

Education

Michigan RN license

Tools

Cerner EHR

Microsoft Office

Job description

Munson Healthcare in northern Michigan is seeking an Utilization Review Specialist (RN) to ensure appropriate utilization of healthcare services across the continuum of care. You will evaluate admissions, continued stays, and transitions of care to align with regulatory requirements and payer guidelines.

Collaborating with physicians, case managers, and payers, you will promote high-quality, cost-effective care while supporting reimbursement and organizational performance; strong clinical