RN Utilization Review Team Lead - Healthcare Management

Great River Health; West Burlington (IA); On-site; USD 81,000 - 99,000; Full time

Benefits offered by this job

Health, Dental and Vision plans

Matching retirement plans

Paid time off (PTO)

Education Assistance Program

Employee Assistance Program

Employee Referral Bonus Program

Discounted cafeteria meals

Parental Leave

Job summary

Great River Health is seeking a Utilization Review Specialist to review clinical documentation for medical necessity and certify admissions in alignment with CMS guidelines.

The role requires an AA nursing degree, active RN license (IBON) and 4–6 years in clinical settings with 1–3 years in Utilization Review. Bachelor’s in Nursing preferred. Schedule includes 8:00am–4:30pm with every 6th weekend; competitive compensation and benefits.

Qualifications

• Associate’s Degree (AA) in Nursing required.
• 4-6 years clinical experience.
• 1-3 years Utilization Review experience.
• Registered Nurse license with Iowa Board of Nursing (IBON) required.
• Bachelor’s Degree in Arts/Sciences (BA/BS) in Nursing preferred.

Responsibilities

• Review inpatient encounters for medical necessity and document review.
• Gather and analyze clinical documentation to support decisions.
• Monitor cases for medical necessity and level of care.
• Lead the Utilization Review team and daily huddles.
• Assist revenue cycle with claim corrections and appeals.

Skills

Clinical review

Medical record analysis

Communication

CMS guidance

Education

Associate’s Degree in Nursing (AA)

RN license (IBON)

Bachelor’s degree in Nursing preferred

Tools

Electronic Medical Records (EMR)

Job description

Great River Health is seeking a Utilization Review Specialist to review clinical documentation for medical necessity and certify admissions in alignment with CMS guidelines.

The role requires an AA nursing degree, active RN license (IBON) and 4–6 years in clinical settings with 1–3 years in Utilization Review. Bachelor’s in Nursing preferred. Schedule includes 8:00am–4:30pm with every 6th weekend; competitive compensation and benefits.