Clinical Utilization Manager

3 weeks ago


Billings, Montana, United States Billings Clinic Full time

**Job Summary:**

Billings Clinic is seeking a highly skilled RN to join our team as a Clinical Utilization Manager. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing costs. This position requires a strong clinical background, excellent communication skills, and the ability to work effectively with various stakeholders.

**Responsibilities:**

  1. Conduct initial, concurrent, and retrospective chart reviews to ensure that hospitalizations are medically necessary and meet payer criteria.
  2. Collaborate with healthcare teams to optimize patient outcomes, reduce length of stay, and minimize delays and denials.
  3. Identify opportunities for expedited appeals and work with payers to resolve issues.
  4. Maintain accurate records and documentation, including utilization review data.

**Requirements:**

  • 4-year degree in nursing or related field
  • 3 years of hospital clinical experience
  • Current RN license in Montana

**Benefits:**

  • Competitive salary range: $73,000 - $93,000 per year
  • Comprehensive benefits package, including medical, dental, vision, and retirement plans
  • Opportunities for professional growth and development

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