Utilization Management RN Date Posted:

26 September 2026

Closing Date:

October 26, 2026

Recruiter:

Mercy Location:

Chesterfield, Missouri Salary:

USD92,000

to

USD112,000

Job Type & Industry:

Business & Management Consultancy Contract Type:

Permanent Job Reference:

2988842689-2 Apply for this job now Job Description Mercy is seeking a Utilization Management RN to support appropriate, cost-effective patient care across our Midwest network. The RN will review medical necessity, treatment plans, and level of care using established clinical criteria, collaborating with physicians, care managers, and payers. Responsibilities include chart review, authorization management, concurrent review, and documentation to support reimbursement and regulatory compliance. Mercy offers a collaborative, mission-driven environment with opportunities for professional growth and continuous learning. Responsibilities Conduct utilization review using standardized clinical criteria Assess medical necessity and appropriate level of care for admissions and continued stays Complete timely concurrent and retrospective chart reviews Coordinate with physicians, nurses, and payers to obtain authorizations Ensure documentation supports reimbursement and regulatory compliance Identify and escalate quality of care or discharge barriers Collaborate with case management and social work on discharge planning Maintain accurate records in EHR and UM systems Monitor utilization trends and participate in performance improvement initiatives Educate clinical staff on utilization management processes and requirements Required Skills Utilization review Care coordination Clinical documentation Concurrent review Inter Qual or MCG criteria Medical necessity assessment Health insurance authorization Regulatory compliance Electronic health records (EHR) Data analysis and reporting