Utilization Review RN: Improve Care & Resource Use

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

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.