Job Title:

Utilization Management Coordinator -

Full Time Location:

Sheridan Community Hospital, Sheridan Michigan Position Summary:

Our hospital is seeking a dedicated Utilization Management Coordinator (RN) to join our team. This role is responsible for coordinating and evaluating the medical necessity, appropriateness, and efficiency of healthcare services for our patients. The ideal candidate will ensure that care is delivered in accordance with hospital policies, payer requirements, and evidence-based standards—supporting optimal patient outcomes while maintaining regulatory compliance.

Responsibilities:

Review patient admissions, continued stays, and discharges for medical necessity and level of care. Collaborate with physicians, nursing staff, case management, and payers to ensure timely and appropriate care delivery. Perform utilization review and documentation in accordance with hospital policies and payer guidelines. Serve as a resource for staff regarding clinical documentation, regulatory standards, and medical necessity criteria. Participate in quality improvement initiatives related to utilization and care coordination. Maintain current knowledge of SI/IS criteria (InterQual) and payer requirements.

Qualifications:

Required:

Current RN license in the state of Michigan.

Education:

Bachelor's degree in Nursing required; Master's degree preferred.

Experience:

Minimum of 3 years of clinical nursing experience. Minimum of 1 year experience in Utilization Management, Clinical Documentation Improvement, and Discharge Planning. Strong analytical, communication, and critical-thinking skills. Proficiency with electronic medical records and documentation systems.