Utilization Review RN: Drive Evidence‑Based Care

CHI Health; Omaha (NE); On-site; USD 85,000 - 105,000; Full time

Job summary

CommonSpirit Health is seeking an Utilization Review Registered Nurse in Omaha, NE to optimize hospital care by validating medical necessity and patient status through established guidelines such as MCG or InterQual. The role requires collaboration with physicians, care coordinators, and payers to ensure smooth care transitions.

The UR RN will conduct admission and concurrent reviews, support denial prevention, and participate in peer-to-peer reviews while maintaining compliance with CMS and

Qualifications

• RN license in NE or IA required.
• 2+ years of acute hospital clinical experience.
• Experience with utilization management programs and clinical criteria application.

Responsibilities

• Perform admission and concurrent stay reviews to validate clinical necessity.
• Engage in denial prevention strategies.
• Coordinate peer-to-peer reviews between providers and payers.
• Communicate critical status updates to stakeholders.
• Ensure regulatory compliance and high-quality patient care.

Skills

Utilization management

CMS standards

Clinical documentation

Time management

Collaboration

Education

BSN

MS in Case Management or related field

Tools

MCG criteria

InterQual criteria

CMS guidelines

Job description

CommonSpirit Health is seeking an Utilization Review Registered Nurse in Omaha, NE to optimize hospital care by validating medical necessity and patient status through established guidelines such as MCG or InterQual. The role requires collaboration with physicians, care coordinators, and payers to ensure smooth care transitions.

The UR RN will conduct admission and concurrent reviews, support denial prevention, and participate in peer-to-peer reviews while maintaining compliance with CMS and