Utilization Review Nurse - Appeals & Care Optimization

Infor; Michigan; On-site; USD 60,000 - 75,000; Full time

Job summary

A healthcare company is seeking a Registered Nurse for Utilization Management in Michigan. This role involves reviewing services and patient care quality, conducting stay reviews, and preparing appeals to payors. Candidates must be licensed in Michigan with three years of clinical experience. Excellent communication and critical thinking skills are essential, with a focus on organizational abilities. This position offers an office environment with standard office equipment.

Qualifications

• Licensed as a Registered Nurse in the State of Michigan.
• Three years of clinical experience required.

Responsibilities

• Reviews services and the quality of patient care.
• Conducts concurrent or stay reviews of hospital resources.
• Prepares and submits appeals to payors.
• Maintains and updates reviews in the EMR.
• Communicates with caregivers about pertinent payor issues.

Skills

Critical thinking skills

Communication skills

Organizational skills

Microsoft Office proficiency

Education

Bachelor’s degree (preferred)

Michigan Registered Nurse License

Job description

A healthcare company is seeking a Registered Nurse for Utilization Management in Michigan. This role involves reviewing services and patient care quality, conducting stay reviews, and preparing appeals to payors. Candidates must be licensed in Michigan with three years of clinical experience. Excellent communication and critical thinking skills are essential, with a focus on organizational abilities. This position offers an office environment with standard office equipment.