Utilization Review Nurse: Optimize Care & Payer Collaboration

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

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.