RN Utilization Review Specialist — Remote Night Shift

Trinity Health MI; Grand Rapids (MI); On-site; USD 86,000 - 100,000; Full time

Job summary

Trinity Health MI in Grand Rapids, MI is seeking a RN for Utilization Review to ensure medical necessity for acute care and to communicate findings to payors.

You will collaborate with Case Management, review admissions and discharges, document in EMR, and support reimbursement processes while working the night shift. A BSN and Michigan RN license are required, with 3 years of acute care experience; utilization management experience preferred.

Qualifications

• Bachelor of Science in Nursing (BSN) required.
• Michigan RN license required.
• Three years of acute care nursing experience.
• Two years of utilization management in acute care preferred.
• Ability to work autonomously with accountability.

Responsibilities

• Conduct utilization reviews to verify medical necessity and document in EMR.
• Provide information to external review organizations to support reimbursement.
• Collaborate with Case Management and health care team.
• Offer consultation to physicians and care team members.

Skills

Utilization review

EMR documentation

Case management liaison

Autonomy

Clinical communication

Education

BSN

Job description

Trinity Health MI in Grand Rapids, MI is seeking a RN for Utilization Review to ensure medical necessity for acute care and to communicate findings to payors.

You will collaborate with Case Management, review admissions and discharges, document in EMR, and support reimbursement processes while working the night shift. A BSN and Michigan RN license are required, with 3 years of acute care experience; utilization management experience preferred.