RN Utilization Review Specialist - Hybrid (MI)

Munson Healthcare; Traverse City, Northern (MI, KY); Hybrid; USD 85,000 - 110,000; Full time

Job summary

Munson Healthcare in Traverse City, MI is seeking a Utilization Review Specialist (RN) for a 50/50 hybrid role with a PM shift (2PM–10:30PM) and weekend rotation every 4/5 weekends.

The specialist will evaluate admissions, ongoing stays, and transitions of care to ensure regulatory compliance and payer guidelines, collaborating with physicians, case management, and payers to promote high‑quality, cost‑effective patient care.

Qualifications

• Current licensure as a Registered Nurse (RN) in Michigan.
• Minimum of three years clinical experience required.
• Strong clinical assessment, critical thinking, and decision-making skills.
• Effective verbal and written communication skills.
• Proficiency in Microsoft Office, Outlook, and related computer applications.
• Ability to independently organize workload, manage competing priorities, and meet deadlines.
• Demonstrated attention to detail and problem-solving abilities.

Responsibilities

• Reviews available documentation to assess admissions for appropriate status and services.
• Applies guidelines to determine inpatient vs. observation level of care.
• Coaches physicians on appropriateness of inpatient or observation status.
• Maintains documentation to support required level of care and transitions.
• Identifies and records delays or bottlenecks in progression of care.
• Collaborates with physicians, case managers, and payers to optimize discharge planning.
• Monitors insurer compliance with contractual obligations and uses review applications.

Skills

Clinical assessment

Critical thinking

Decision-making

Verbal communication

Written communication

Microsoft Office

Outlook

Tools

Microsoft Office

Job description

Munson Healthcare in Traverse City, MI is seeking a Utilization Review Specialist (RN) for a 50/50 hybrid role with a PM shift (2PM–10:30PM) and weekend rotation every 4/5 weekends.

The specialist will evaluate admissions, ongoing stays, and transitions of care to ensure regulatory compliance and payer guidelines, collaborating with physicians, case management, and payers to promote high‑quality, cost‑effective patient care.