RN Utilization Review Case Manager
$66,560–$99,840 year
On-site · Granite City, Illinois, United States
Job Summary
Utilization Review Specialist RN at Gateway Regional Medical Center performs admission and concurrent reviews to prevent denials and manages appeals, collaborating with interdisciplinary teams to improve utilization workflows and ensure timely resolutions in accordance with payer, regulatory, and accreditation standards. Requires nursing degree from an accredited program, active Illinois RN license, BLS certification, and at least five years of acute care clinical nursing experience with exposure to case management, discharge planning, utilization review, or appeals management. The role focuses on optimizing utilization of resources and achieving quality patient outcomes within a full-time, hospital-based setting in Granite City, IL.
Required Qualifications
- Graduate of an Accredited School of Professional Nursing
- Current Illinois Nursing License
- Current Basic Life Support (AHA or American Red Cross BLS) certification
- Minimum of five years of clinical nursing experience in an acute care setting
- Experience in case management, discharge planning, utilization review, or appeals management preferred
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