Utilization Review Nurse: Care Coordination & Appeals

MACON HOSPITAL INC; Lafayette (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

MACON COMMUNITY HOSPITAL is seeking a Utilization Review Nurse to join the Care Management team. The role collaborates with interdisciplinary staff to review admissions, length of stay, and service use, supporting cost‑effective patient care and discharge planning.

Requirements include Tennessee RN license, UR/UM certification preferred, 2–3 years in health care, strong communication, and ability to work independently.

Qualifications

• Current registered nursing license in Tennessee.
• Certification in Utilization Review or Utilization Management preferred.
• Graduate from accredited school of nursing; BSN preferred.

Responsibilities

• Evaluates admissions, treatment, length of stay, and resource use.
• Participates in appeals/denials and discharge planning.
• Collaborates with interdisciplinary teams to improve quality and cost effectiveness.
• Coordinates Peer Review activities as part of the role.

Skills

Communication skills

Team collaboration

Independence

Professionalism

Education

RN license in TN

BSN preferred

Job description

MACON COMMUNITY HOSPITAL is seeking a Utilization Review Nurse to join the Care Management team. The role collaborates with interdisciplinary staff to review admissions, length of stay, and service use, supporting cost‑effective patient care and discharge planning.

Requirements include Tennessee RN license, UR/UM certification preferred, 2–3 years in health care, strong communication, and ability to work independently.