Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Active RN license (state-specific requirement applies) * Minimum of 2 years of acute care nursing experience * Prior utilization review, case management, or payer review experience preferred * Strong ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
Utilization Review RN
Indianapolis, IN · On-site
... reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. Qualifications * Must have clear and active RN license in the state of IN * AS ...
Utilization Review RN
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
Utilization Review RN
$30 - $34/hr
Expected to review 20 cases a day with a 95% accuracy rate. Responsible for collaborating with ... Must have clear and active RN license in the state of IN * 2 years of experience in a acute care ...
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
... Utilization Review Coordinator to coordinate patients' services across the continuum of care by ... Cooperates and maintains good rapport with nursing staff, medical staff, and other departments.
Utilization Management Nurse
Columbus, IN · On-site
This position is reserved for a licensed Registered Nurse who will perform the Utilization ... By performing review of services prospectively, retrospectively, and throughout the episode of care ...
Utilization Management Nurse
Columbus, IN · On-site
This position is reserved for a licensed Registered Nurse who will perform the Utilization ... By performing review of services prospectively, retrospectively, and throughout the episode of care ...
Utilization Management Nurse
Columbus, IN · On-site
This position is reserved for a licensed Registered Nurse who will perform the Utilization ... By performing review of services prospectively, retrospectively, and throughout the episode of care ...
Quick apply
Utilization Management Nurse
Columbus, IN · On-site
This position is reserved for a licensed Registered Nurse who will perform the Utilization ... By performing review of services prospectively, retrospectively, and throughout the episode of care ...
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
The Utilization Specialist is responsible for reviewing of assigned admissions, continued stays ... Graduation from an approved/accredited school of nursing or a Bachelor's degree in social work ...
RN Case Manager
Hammond, IN · On-site
The RN Case manager provides education to physicians and other members of the team on the issues related to utilization review including appropriateness of admission, level of care and external ...
RN Case Manager
Hammond, IN · On-site
The RN Case manager provides education to physicians and other members of the team on the issues related to utilization review including appropriateness of admission, level of care and external ...
RN Care Manager
Evansville, IN · On-site
$85K - $95K/yr
Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS, prevent readmissions, improve outcomes ✅ What You Bring: * Active RN license (Indiana or compact)
Quick apply
RN Care Manager
Evansville, IN · On-site
$85K - $95K/yr
Perform utilization review (UR) and payer communication * Support hospital goals: reduce LOS, prevent readmissions, improve outcomes ✅ What You Bring: * Active RN license (Indiana or compact)
Secondary Review Nurse - Indiana
Indianapolis, IN · Remote
$29 - $52/hr
Monitor utilization patterns and identify opportunities for improved care coordination and cost ... Current, unrestricted RN license for Indiana * 3 years of clinical experience in a hospital, acute ...
New
Secondary Review Nurse - Indiana
Indianapolis, IN · Remote
$29 - $52/hr
Monitor utilization patterns and identify opportunities for improved care coordination and cost ... Current, unrestricted RN license for Indiana * 3 years of clinical experience in a hospital, acute ...
New
Registered Nurse (RN) Case Manager - Community East Emergency Community Health Network was created ... utilization review and management and discharge planning. Has accountability for the care ...
Registered Nurse (RN) Case Manager - Community East Emergency Community Health Network was created ... utilization review and management and discharge planning. Has accountability for the care ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
Registered Nurse - RN
Evansville, IN · On-site
$85K - $950K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Quick apply
Registered Nurse - RN
Evansville, IN · On-site
$85K - $950K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
The Registered Nurse Case Manager is responsible for the assessment, planning, implementation ... utilization review and management and discharge planning. Has accountability for the care ...
Registered Nurse - RN
Evansville, IN · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Quick apply
Registered Nurse - RN
Evansville, IN · On-site
$85K - $95K/yr
The Registered Nurse (RN) Care Manager plays a vital role in providing exceptional, patient ... Participate actively in team meetings, quality improvement projects, and utilization review ...
Entry Level Rn Utilization Review Nurse information
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Part-time
Medical, Dental, Vision, Life, Retirement, PTO
Re-posted 17 days ago
Trinity Health rating
6.6
Based on 354 frontline employees who took The Breakroom Quiz
570th of 887 rated healthcare providers
Job description
Employment Type:Part timeShift:Rotating ShiftDescription:This is a remote position but will need onsite training in Mishawaka Indiana.
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Shift: PRN/Days - 8 hr shift
Considering local candidates only!!!
Why Choose Saint Joseph Health System?
At Saint Joseph Health System, our values guide every decision we make. Even when challenges arise, we remain committed to our mission: caring for every person who needs us. We invest in our people, our technology, and our capabilities so we can continue delivering exceptional, compassionate care to our communities.
Tuition reimbursement for all full-time and part-time colleagues starting on day one
Comprehensive benefits beginning day one (Medical, Dental, Vision, PTO, Life Insurance, STD/LTD, and more)
Retirement savings plan with employer match
Generous paid time off program plus 7 paid holidays
No mandatory overtime
Employee referral incentive program
Access to state-of-the-art equipment, unlimited CEUs, and a supportive team-focused work environment
- Conduct clinical reviews of patient records to evaluate medical necessity, appropriateness of admission, treatment, and length of stay across all payor types
- Apply standardized criteria, regulatory guidelines, and insurance requirements to support reimbursement and compliance
- Collaborate with physicians, nursing staff, and interdisciplinary teams to ensure appropriate resource utilization and care planning
- Review admissions and ongoing patient cases; recommend or escalate cases that do not meet criteria to leadership or the Utilization Review Committee
- Facilitate timely discharges, transfers, and recertifications when level of care is no longer appropriate
- Partner with Medicare, Medicaid, and private insurers to ensure accurate documentation and reimbursement processes
- Respond to denials and authorization changes by reviewing medical records and communicating outcomes to care teams and patients
- Identify trends and utilization concerns; contribute to performance improvement and quality initiatives
- Maintain accurate records, compile reports, and support utilization review program operations
- Provide education to clinical staff on documentation requirements, coverage guidelines, and utilization processes
- Support compliance with all regulatory, accreditation, and organizational standards
- Participate in committee meetings and assist in development of utilization review plans and processes
- Graduate of an accredited Registered Nurse (RN) program; Bachelor's Degree in Nursing preferred
- Active RN license (state-specific requirement applies)
- Minimum of 2 years of acute care nursing experience
- Prior utilization review, case management, or payer review experience preferred
- Strong knowledge of Medicare, Medicaid, and commercial insurance guidelines
- Solid understanding of clinical care practices, diagnoses, treatment modalities, and hospital operations
- Excellent communication skills with the ability to collaborate effectively across teams
- Strong analytical and critical thinking skills to assess clinical appropriateness and compliance
- Proficiency in computer systems and Microsoft Office applications
- Ability to manage multiple priorities in a fast-paced healthcare environment
- Flexibility to adapt to changing schedules, workflows, and departmental needs
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
What Trinity Health employees say
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About Trinity Health
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Trinity Health Ann Arbor is a 537 -bed teaching hospital located on 340 acre campus. Recognized by IBM Watson as a Top 100 Hospital and #1 Teaching Hospital, Trinity Health Ann Arbor has been a leading health care provider for more than 100 years. Trinity Health has received numerous local and national awards in recognition of our leadership, quality outcomes, and clinical excellence.
Industry
Health care and social assistance
Company size
10,000+ Employees
Headquarters location
Livonia, MI, US