Utilization Review Nurse | Admissions & CDI

Nevada Regional Medical Center; Nevada (MO); On-site; USD 23,000 - 33,000; Full time

Job summary

Nevada Regional Medical Center is seeking a Utilization Review & Discharge Coordinator to manage patient stays, approval submissions, and medical necessity reviews. The role involves coordinating discharge planning for BHU and Acute Care, and handling insurance submissions with a focus on quality outcomes.

Ideal candidates bring nursing, respiratory care, or social work background with licensure and strong awareness of payer processes.

Qualifications

• Graduate of an accredited nursing, respiratory care, or social work program with licensure; Missouri licensure preferred.
• Experience in utilization review, discharge planning, or insurance submissions is desirable.
• Ability to interpret medical necessity criteria and coordinate with payers.

Responsibilities

• Authorize patient stays and manage discharge planning activities.
• Submit insurance pre-authorization for hospital admissions and continued stays.
• Submit discharge reports to insurance and manage appeals/peer‑to‑peer requests.
• Perform InterQual submissions for medical necessity.
• Participate in utilization review committee activities and CDI management.
• Oversee Swing Bed intake and related duties within scope of practice.

Skills

Discharge planning

UR / Utilization review

InterQual submissions

Appeals & peer-to-peer

CDI management

Insurance discharge submissions

Education

Licensed Practical Nurse / Registered Nurse / Respiratory Care / Social Work degree

Job description

Nevada Regional Medical Center is seeking a Utilization Review & Discharge Coordinator to manage patient stays, approval submissions, and medical necessity reviews. The role involves coordinating discharge planning for BHU and Acute Care, and handling insurance submissions with a focus on quality outcomes.

Ideal candidates bring nursing, respiratory care, or social work background with licensure and strong awareness of payer processes.