Clinical Utilization Review Specialist

3 weeks ago


Hancock, Michigan, United States LifePoint Health Full time

We are seeking a detail-oriented Utilization Review Registered Nurse to join our team at UP Health System - Portage. As a Utilization Review RN, you will be responsible for prior authorizations for the Inpatient Unit, Labor and Delivery, and outpatient testing, as well as determining medical necessity of patients while hospitalized.

This role requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. You will work independently with proven organizational skills and attention to detail, prioritizing multiple tasks and exercising sound judgment.

The ideal candidate will have an Associate's Degree in Nursing, a State of Michigan RN license, and nursing experience. Case management or utilization experience is preferred. Basic Life Support (BLS) certification is required, and annual influenza vaccination or declination is also required.

This is a part-time position, working 24 hours per week, Monday through Friday, with a day shift schedule.

Key Responsibilities:

  • Prior authorization for Inpatient Unit, Labor and Delivery, and outpatient testing
  • Determining medical necessity of patients while hospitalized
  • Working independently with minimal supervision
  • Prioritizing multiple tasks and exercising sound judgment

Requirements:

  • Associate's Degree in Nursing
  • State of Michigan RN license
  • Nursing experience
  • Case management or utilization experience preferred
  • Basic Life Support (BLS) certification
  • Annual influenza vaccination or declination


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