Utilization Review RN

CommonSpirit Health; Glenwood (TN); On-site; USD 70,000 - 100,000; Full time

Job summary

CommonSpirit Health is seeking an Utilization Management Professional to safeguard healthcare efficiency and quality. You will review medical records, authorize services, and prepare cases for physician review in partnership with UM teams.

You will monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria. A strong clinical background and UM/regulatory knowledge are essential for success.

Qualifications

• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
• RN license in the state(s) covered is required.
• BLS required within 3 months of hiring.

Responsibilities

• Review medical records and authorize services.
• Prepare cases for physician review with UM teams.
• Monitor patient care for appropriateness, quality, and cost-effectiveness.
• Apply criteria precisely and communicate with empathy and efficiency.

Skills

Clinical background

UM/regulatory knowledge

Analytical skills

Organizational skills

Effective communication

Education

RN license (state)

Masters in Case Management or Nursing

CCM/ACM-RN/UM Certification (preferred)

Job description

Job Summary and Responsibilities

As our Utilization Management Professional, you will be a critical guardian of healthcare efficiency and quality, ensuring integrity in clinical decision-making, regulatory compliance, and responsible resource utilization.

Every day, you will meticulously review medical records, authorize services, and prepare cases for physician review in partnership with UM teams. You'll monitor patient care for appropriateness, quality, and cost-effectiveness, aligning decisions with established criteria.

To be successful in this role, you will possess a strong clinical background, deep UM/regulatory knowledge, and exceptional analytical/organizational skills. Your ability to manage charts, apply criteria precisely, and communicate effectively with enthusiasm, efficiency, and empathy is paramount for optimal patient care and operational flow.

Job Requirements

Required

• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience.
• RN license in the state(s) covered is required.
• BLS required within 3 months of hiring

Preferred

• Graduate of an accredited school of nursing (Bachelor Degree in Nursing (BSN)) or related healthcare field.
• At least five (5) years of nursing experience.
• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred

Where You'll Work

CommonSpirit Memorial is an award-winning, not-for-profit, faith-based health care organization dedicated to the healing ministry of Jesus Christ. Founded by the Sisters of Charity of Nazareth, we offer a comprehensive continuum of care, from preventative and primary care to acute hospital services specializing in cancer, cardiac, neuroscience, stroke, and orthopedic services. Our commitment to excellence has earned us top prestigious recognition repeatedly from U.S. News and World Report, PINC AI™, CMS, Healthgrades®, Leapfrog, and most recently as one of the Best Places to Work in Tennessee. We are proud to serve Southeast Tennessee and Northwest Georgia with the expertise of 4,700 employees and nearly 500 affiliated physicians.