Utilization Review Nurse Specialist

3 days ago


Kansas City, Missouri, United States Saint Luke's Health System Kansas City Full time
Job Summary:

The Healthcare Utilization Analyst RN is responsible for ensuring high-quality, cost-effective medical outcomes through utilization review and management. This role involves monitoring patient charts and the utilization of healthcare services. Collaborating with physicians, Care Coordinators, Social Workers, and other members of the multidisciplinary revenue cycle teams.

* Completes initial and concurrent reviews; identifies appropriate level of service and length of stay, using clinical guidelines (InterQual).

* Complies with CMS regulations regarding utilization review/management. A strong understanding of these regulations is essential for this position. Key responsibilities include:
  • • Obtaining and managing insurance authorizations
    • Proactively working denials to mitigate financial impact


* Submits referrals for secondary-level review as necessary and follows through on the process. Effective communication and documentation are vital in this role. An associate degree and registered nurse licensure are required for this position. The salary range for this position is $80,000 - $110,000 annually, depending on experience. Benefits include health, dental, and vision insurance, paid time off, and opportunities for professional growth within the Saint Luke's Health System Kansas City.

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