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Utilization Review Nurse, RN
Trinity HealthUtilization Review Nurse ensuring appropriate admission status and level of care for hospitalized patients. Collaborating closely with healthcare professionals to support authorizations and discharge planning.
About the role
Key responsibilities & impact- Ensure appropriate admission status and level of care for hospitalized patients
- Partner closely with physicians, physician advisors, case management, and payers
- Support timely authorizations, concurrent reviews, and discharge planning
- Conduct initial and concurrent chart reviews to confirm admission and continued stay meet level-of-care criteria
- Provide telephonic or electronic clinical reviews to external payers to support authorization decisions.
Requirements
What you’ll need- Experience in Utilization Review, Case Management, or Managed Care
- Working knowledge of MCG/InterQual (Indicia) criteria
- Familiarity with CMS, Medicare, Medicaid, and commercial payer regulations
- Proficiency with Epic or similar EMR systems
- Strong clinical judgment, communication, and documentation skills.
Benefits
Comp & perks- Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings.
- Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
Utilization ReviewCase ManagementManaged CareMCG criteriaInterQual criteriaCMS regulationsMedicare regulationsMedicaid regulationsEpic EMRclinical reviews
Soft Skills
clinical judgmentcommunication skillsdocumentation skills