Utilization Review Nurse | Case Management Expert

Singing River Health System; Ocean Springs (MS); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Best-of-industry benefits

Scheduling options

Professional pathways

Job summary

Singing River Health System is seeking an Utilization Review Nurse at Singing River Ocean Springs Hospital to ensure medical necessity and appropriate levels of care through concurrent and retrospective reviews.

You will stay current on payer requirements and DNV guidelines, collaborate with the Utilization Management Director, and thrive in a high-pressure environment demanding attention to detail and strong communication.

Qualifications

• Graduate from an accredited school of Nursing; Bachelor’s degree preferred.
• Current Mississippi nursing license.
• ACMA or CCM certification preferred and must have de-escalation training by orientation (90 days).
• Five years’ acute care nursing and/or case management experience; utilization or case management preferred.

Responsibilities

• Perform concurrent and retrospective reviews to evaluate medical necessity and level of care.
• Determine patient status and facilitate the use of appropriate level of care.
• Maintain up-to-date knowledge of payer requirements and DNV regulations for UR.

Skills

De-escalation training

Clinical judgment

Communication skills

Multitasking

Education

Bachelor’s degree in Nursing

Tools

EMR systems

MS Outlook

Microsoft Word

Job description

Singing River Health System is seeking an Utilization Review Nurse at Singing River Ocean Springs Hospital to ensure medical necessity and appropriate levels of care through concurrent and retrospective reviews.

You will stay current on payer requirements and DNV guidelines, collaborate with the Utilization Management Director, and thrive in a high-pressure environment demanding attention to detail and strong communication.