RN Utilization Review Case Manager

RN Utilization Review Case Manager Gateway Regional Medical Center - 3.0 Granite City, IL Job Details Full-time $32 - $48 an hour 1 day ago Benefits Paid holidays Dental insurance Vision insurance Retirement plan Qualifications RN License BLS Certification Acute care Full Job Description We are Gateway Regional Medical Center Our mission is to provide compassionate, high-quality healthcare services to our community, promoting wellness and healing through innovative treatments, advanced technology, and a dedicated team of professionals. We are committed to fostering a culture of respect, integrity, and excellence, ensuring that every patient receives personalized care in a safe and nurturing environment. Together, we strive to enhance the health and well-being of those we serve and to be a trusted partner in their journey to better health.

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 Benefits Guide 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.