Utilization Review Nurse

CommonSpirit Health; Little Rock (AR); On-site; USD 75,000 - 95,000; Full time

Job summary

CommonSpirit Health is seeking an Utilization Review Nurse in Arkansas. The role ensures medical necessity, appropriateness, and efficiency of inpatient hospital services by reviewing charts and coordinating with payers for timely authorizations.

Collaborate with physicians and health-care teams to ensure optimal care, cost-effectiveness, and adherence to departmental policies. Requires RN with BSN or CCM/ACM within 2 years of hire.

Qualifications

• Registered Nurse with Bachelor’s degree or diploma/Associate’s with CCM/ACM within 2 years of hire.

Responsibilities

• Review inpatient charts for medical necessity and appropriate utilization.
• Coordinate with payers to obtain timely authorizations.
• Collaborate with physicians and care team to ensure appropriate and cost-effective treatment.
• Apply clinical criteria to validate admission status and prevent denials.

Skills

RN experience

Hospital coordination

Care management knowledge

Education

BSN or diploma/associate with CCM/ACM

Job description

Job Summary and Responsibilities

The Utilization Review Nurse is responsible for ensuring the medical necessity, appropriateness, and efficiency of inpatient hospital services. This role involves conducting concurrent and retrospective reviews of patient charts, applying standardized clinical criteria to validate admission status, and coordinating with insurance payers to secure timely authorizations. The UR Nurse serves as a vital liaison between the clinical care team and insurance providers to prevent claim denials, facilitate smooth transitions of care, and optimize hospital reimbursement.

He/she works collaboratively with physicians and other members of the health care team to ensure that the patient gets the right treatment from resources that are available in the hospital with the most cost effective use of available resources. Is held accountable for policies and procedures of the department and organization.

Job Requirements

Registered Nurse with Bachelor's degree or diploma/Associate's degree with Care Management certification within 2 years of hire date (CCM or ACM)

Bachelor’s Degree in Nursing (BSN) Minimum of four (4) years of experience as a RN

Requires Minimum of three years in acute care hospital
Preferred – experience in Case Management, discharge planning or utilization management role

Where You'll Work

CHI St. Vincent, a regional health network serving Arkansas, is part of CommonSpirit Health. We have served Arkansas since 1888 with a history of many firsts. Together with more than 4500 coworkers, 1000 medical staff and 500 volunteers we consistently receive praise for care advancements. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. CHI St. Vincent provides you with the same level of care you provide to others. We care about our team member well-being and offer benefits that complement and support your work/life balance.