RN Utilization Review Specialist - Part Time, Day Shift

University of Mississippi Medical Center; Jackson, Northern (MS, KY); Hybrid; USD 42,000 - 62,000; Part time

Job summary

University of Mississippi Medical Center is seeking a part-time RN for Utilization Review. The role involves performing prospective, concurrent, retrospective, and denial reviews to assess medical necessity and appropriate level of care.

You will collaborate with healthcare teams, gather data, and report indicators to improve quality and efficiency. The ideal candidate holds an active RN license and at least one year of inpatient nursing experience, with strong knowledge of medical coding and

Qualifications

• One year of nursing experience in an inpatient setting.
• Valid RN license.
• Knowledge of utilization review, discharge planning, case management, and managed care reimbursement.

Responsibilities

• Performs prospective, concurrent, retrospective, and denials review for individual cases, including benefit coverage and medical necessity.
• Collects and analyzes variances from the plan of care and collaborates with physicians and the healthcare team to address issues and improve outcomes.
• Communicates with third-party payers to facilitate reimbursement and complete utilization management and quality screening for assigned patients.
• Works with the care team to remove barriers to care and ensure timely patient management.

Skills

Utilization review

Discharge planning

Case management

Medical terminology

Data collection

Report writing

Tools

EHR systems

Job description

University of Mississippi Medical Center is seeking a part-time RN for Utilization Review. The role involves performing prospective, concurrent, retrospective, and denial reviews to assess medical necessity and appropriate level of care.

You will collaborate with healthcare teams, gather data, and report indicators to improve quality and efficiency. The ideal candidate holds an active RN license and at least one year of inpatient nursing experience, with strong knowledge of medical coding and