Utilization Review RN — Part-Time, Day Shift

Trinity Health MI; Ann Arbor (MI); On-site; USD 50,000 - 76,000; Part time

Job summary

The Utilization Review Specialist at Trinity Health MI is a Registered Nurse responsible for collecting patient clinical information and applying clinical criteria, considering age, development, culture, and spiritual needs. This contingent, part-time role supports weekday and weekend coverage with two shifts every other weekend including a holiday commitment roughly once every 18 months.

Shifts are eight hours with start times typically between 6 a.m.

Qualifications

• Graduation from an accredited nursing program; new hires must have a BSN or agree in writing to obtain BSN within five years from date of hire.
• Two to three years related experience and clinically relevant knowledge regarding patient population.
• Current Registered Nurse license in the State of Michigan (RN).

Responsibilities

• Completes submission of utilization review documentation for concurrent and retrospective patients within established timelines.
• Ensures authorizations are obtained and communicated to ePFS teams in a timely manner.
• Identifies and resolves errors related to patient demographic and insurance information.
• Submits utilization review documentation for payer reviews and documents the date sent and authorizations obtained.
• Communicates with case managers and physician advisors and coordinates with payer Medical Directors.
• Coordinates the peer-to-peer concurrent appeal process and ensures timely denials identification.
• Maintains positive relationships with Care Management, Physician Advisors, ePFS, Patient Access, and other departments to support timely remuneration.
• Identifies process improvement opportunities and documents assessments, interventions, transitions, and outcomes per standards.

Education

BSN degree or commitment to obtain BSN within five years

Current RN license in Michigan (RN)

Job description

The Utilization Review Specialist at Trinity Health MI is a Registered Nurse responsible for collecting patient clinical information and applying clinical criteria, considering age, development, culture, and spiritual needs. This contingent, part-time role supports weekday and weekend coverage with two shifts every other weekend including a holiday commitment roughly once every 18 months.

Shifts are eight hours with start times typically between 6 a.m.