RN Utilization Review Specialist — Hybrid Role

Munson Healthcare; Traverse City (MI); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Tuition reimbursement

Full benefits

Generous PTO

Employee discounts

Retirement counseling

Wellness platform

Be Heard initiatives

Job summary

Munson Healthcare in Michigan seeks an experienced Utilization Review Specialist (RN) to ensure appropriate utilization of services across the continuum of care. You will review admissions, stays, and transitions with physicians, case managers, and payers to support compliant, high‑quality care.

The role requires clinical judgment, strong communication, and knowledge of regulatory guidelines. Typical schedule is 2 PM–10:30 PM with weekend rotation; 50/50 hybrid and onsite.

Qualifications

• Current licensure as an 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 and meet deadlines.
• Attention to detail and problem-solving abilities.

Responsibilities

• Reviews admissions to assess appropriate status and services.
• Determines inpatient vs observation using guidelines.
• Coaches physicians on inpatient vs observation status.
• References Physician Advisor when documentation is inadequate.
• Maintains proficiency in CERMe, EMR, and hospital systems.
• Participates in daily huddles and care conferences.
• Collaborates with case managers, physicians, and payers to resolve barriers.
• Applies Interqual/Milliman screens for discharge readiness.

Skills

Clinical assessment

Critical thinking

Decision making

Communication skills

Education

Registered Nurse license (MI)

Tools

Microsoft Office

Cerner EHR

Job description

Munson Healthcare in Michigan seeks an experienced Utilization Review Specialist (RN) to ensure appropriate utilization of services across the continuum of care. You will review admissions, stays, and transitions with physicians, case managers, and payers to support compliant, high‑quality care.

The role requires clinical judgment, strong communication, and knowledge of regulatory guidelines. Typical schedule is 2 PM–10:30 PM with weekend rotation; 50/50 hybrid and onsite.