Utilization Review RN: Optimize Care & Payer Compliance

CHI Health; Omaha (NE); On-site; USD 85,000 - 100,000; Full time

Job summary

CHI Health in Omaha seeks an Utilization Review RN to ensure medical necessity and appropriate patient status throughout hospitalization. You will apply evidence-based guidelines (MCG or InterQual) and collaborate with physicians, consultants, and care coordination teams to support safe, efficient patient care transitions.

You will review admissions and concurrent stays, prevent denials, coordinate peer-to-peer reviews with payers, and communicate status updates to stakeholders.

Qualifications

• Graduate of an accredited school of nursing.
• Active RN license in NE or IA at hire.
• Minimum two (2) years of acute hospital clinical experience.
• Utilization management experience and CMS standards knowledge.

Responsibilities

• Perform admission and concurrent stay reviews to validate medical necessity.
• Apply clinical criteria from MCG or InterQual guidelines.
• Collaborate with attending physicians, consultants and care coordination teams.
• Coordinate peer-to-peer reviews with payers and communicate status updates to stakeholders.

Skills

Acute hospital experience

Utilization management

Clinical criteria application

Time management

Collaborative mindset

Education

RN license - NE/IA

MS or higher in Case Management or Nursing

Tools

MCG/InterQual guidelines

Job description

CHI Health in Omaha seeks an Utilization Review RN to ensure medical necessity and appropriate patient status throughout hospitalization. You will apply evidence-based guidelines (MCG or InterQual) and collaborate with physicians, consultants, and care coordination teams to support safe, efficient patient care transitions.

You will review admissions and concurrent stays, prevent denials, coordinate peer-to-peer reviews with payers, and communicate status updates to stakeholders.