Strategic RN: Utilization Management & Care Coordination

Sheridan Community Hospital; Sheridan Township (MI); On-site; USD 85,000 - 105,000; Full time

Job summary

Sheridan Community Hospital in Sheridan, Michigan, seeks a dedicated Utilization Management Coordinator (RN) to oversee medical necessity, appropriateness, and efficiency of care. This role collaborates with physicians, nurses, case management, and payers to ensure compliant, timely care delivery.

The ideal candidate has MI RN licensure, a BSN, and at least 3 years of clinical nursing experience, with 1 year in utilization management or discharge planning.

Qualifications

• Current RN license in Michigan is required.
• Bachelor’s degree in Nursing is required; Master’s degree preferred.
• Minimum of 3 years of clinical nursing experience.
• Minimum of 1 year in Utilization Management, Clinical Documentation Improvement, and Discharge Planning.
• Strong analytical, communication, and critical-thinking skills.
• Proficiency with electronic medical records and documentation systems.

Responsibilities

• Review patient admissions, continued stays, and discharges for medical necessity and level of care.
• Collaborate with physicians, nursing staff, case management, and payers to ensure timely and appropriate care delivery.
• Perform utilization review and documentation in accordance with hospital policies and payer guidelines.
• Serve as a resource for staff regarding clinical documentation, regulatory standards, and medical necessity criteria.
• Participate in quality improvement initiatives related to utilization and care coordination.
• Maintain current knowledge of SI/IS criteria (InterQual) and payer requirements.

Skills

Analytical skills

Communication skills

Critical thinking

Education

Bachelor's degree in Nursing

Master's degree in Nursing or related

Tools

Electronic Medical Records (EMR)

InterQual knowledge

Job description

Sheridan Community Hospital in Sheridan, Michigan, seeks a dedicated Utilization Management Coordinator (RN) to oversee medical necessity, appropriateness, and efficiency of care. This role collaborates with physicians, nurses, case management, and payers to ensure compliant, timely care delivery.

The ideal candidate has MI RN licensure, a BSN, and at least 3 years of clinical nursing experience, with 1 year in utilization management or discharge planning.