Position Overview:The Utilization Review Specialist RN assumes responsibility and accountability for admission and concurrent reviews to ensure the prevention of denials from all payers, as well as coordination and management of appeals for accounts deemed appropriate for appeal. This role supports compliance with payer, regulatory, and accreditation standards while promoting efficient utilization of healthcare resources and quality patient outcomes. The Specialist works collaboratively with interdisciplinary teams to identify denial trends, improve workflows, and ensure timely resolution of utilization review and appeals processes.
Specifics:- -Position: Utilization Review Specialist RN
- -Department: Case management
- -Location: Gateway Regional Medical Center 2100 Madison Ave. Granite City, IL 62040
- -Position Status: Full-time
Education Qualifications:- Required: Graduate of an Accredited School of Professional Nursing
Certification Qualifications:- Required: Current Illinois Nursing License
- Required: Current Basic Life Support (AHA or American Red Cross BLS) certification
- Preferred: Knowledge of InterQual and/or Milliman criteria
Experience Qualifications:- Minimum of five years of clinical nursing experience in an acute care setting required.
- Experience in case management, discharge planning, utilization review, or appeals management preferred.
Company Benefits:- Competitive salary and performance-based incentives
- Comprehensive health, dental, and vision insurance plans. Click to see all available
- Retirement savings plan with employer matching
- Vacation time and holiday pay
- Supportive and inclusive work environment
Pay Range:- The pay range for this position is $32.00 - 48.00 per hour.
Disclaimer: Pay is determined based on various factors, including education level, years of experience, relevant certifications, and specific skills related to the position. The final compensation package will be discussed with Human Resources to ensure fairness and alignment with the candidate's qualifications.
