Utilization Review RN — Impactful Day-Shift Role

Trinity Health; Des Moines (IA); On-site; USD 70,000 - 100,000; Full time

Job summary

MercyOne Des Moines Medical Center, part of MercyOne Health System, is seeking a skilled Utilization Review Nurse for a full-time Day Shift in Des Moines, Iowa. You will review inpatient and outpatient admissions, collaborate with physicians and case management, and ensure accurate payer documentation.

Iowa RN licensure and five years of nursing experience are required; BSN preferred. Join a leading regional health system offering competitive compensation and comprehensive benefits while

Qualifications

• Current Iowa RN licensure.
• Minimum 5 years clinical nursing experience.
• BSN or healthcare-related degree preferred.
• Must complete Mandatory Reporter abuse training within 3 months.
• Knowledge of insurance eligibility for healthcare services.
• Ability to work independently and exercise judgement.
• UR specialty certification within 12 months preferred.

Responsibilities

• Conducts admission review per the Utilization Management Plan to ensure hospitalization eligibility.
• Collaborates with physicians and Case Management for status changes.
• Manages payer authorizations and documentation in STAR system.
• Engages in Peer to Peer discussions with payers when needed.
• Ensures timely communication and accurate record updates.
• Participates in RAC/appeals workflows as required.
• Supports observation status monitoring and denials workflows.

Skills

RN license Iowa

5 years nursing experience

BSN preferred

Mandatory reporter training

Insurance eligibility knowledge

Independent judgement

UR certification

Education

Bachelor of Science in Nursing

Job description

MercyOne Des Moines Medical Center, part of MercyOne Health System, is seeking a skilled Utilization Review Nurse for a full-time Day Shift in Des Moines, Iowa. You will review inpatient and outpatient admissions, collaborate with physicians and case management, and ensure accurate payer documentation.

Iowa RN licensure and five years of nursing experience are required; BSN preferred. Join a leading regional health system offering competitive compensation and comprehensive benefits while