Utilization Management RN Lead — Clinical SME & Operations

Bryan College Of Health Sciences; Lincoln (NE); On-site; USD 85,000 - 110,000; Full time

Job summary

Bryan Health in Lincoln, NE seeks an experienced Utilization Management RN to oversee daily UM activities, validate medical necessity, and obtain authorizations. You will coordinate with hospital staff, physicians, and families to support financial and clinical outcomes.

The role requires RN licensure in Nebraska (or an approved compact state) and 5+ years in UM, with strong knowledge of CMS rules and payer guidelines. CPR/BLS certification preferred; on-site position within a collaborative team.

Qualifications

• Maintains clinical competency and annual skill verification.
• Knows CMS and third-party payer regulations for hospitalization.
• Excellent written and verbal communication; can handle crucial conversations.
• Ability to manage confidential information and work with minimal supervision.
• Prioritizes workload and maintains regular, punctual attendance.

Responsibilities

• Serve as manager when the manager is unavailable.
• Act as SME for Utilization Management department in reviews.
• Assist in streamlining operations and maximizing UM tools.
• Represent UM in meetings and committee discussions.
• Determine medical necessity through first-level reviews using guidelines.
• Perform utilization review activities including concurrent/retrospective reviews.
• Collaborate with providers and care teams to manage length of stay.
• Participate in denials and appeals process with issue research and follow-up.
• Advise on appropriate level of care and discharge planning; stay utilization.

Skills

Clinical competency

CMS knowledge

Communication

Conflict resolution

Critical thinking

Confidentiality

Time management

Attendance

Education

RN licensure Nebraska/compact state

5+ years utilization management experience

Job description

Bryan Health in Lincoln, NE seeks an experienced Utilization Management RN to oversee daily UM activities, validate medical necessity, and obtain authorizations. You will coordinate with hospital staff, physicians, and families to support financial and clinical outcomes.

The role requires RN licensure in Nebraska (or an approved compact state) and 5+ years in UM, with strong knowledge of CMS rules and payer guidelines. CPR/BLS certification preferred; on-site position within a collaborative team.