Utilization Review RN
Mosaic Life Care
St Joseph, MO, USA
USD 32-51.2 / hour
Posted on Aug 1, 2025
Details
- Utilization Review RN
- IP Psychiatry
- PRN Status
- Variable Shift
- Pay: $32.00 - $51.20 / hour
- This position will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. This position collaborates with UM Specialists, Physician Advisor, and various departments regarding medical necessity of hospital stays from admission authorizations to discharge, including denials and appeals. Strong communication skills are necessary to access available resources and communicate with providers and other members of the interdisciplinary team. Active participation in program development and process improvement efforts is an expectation.
- This position is employed by Mosaic Health System.
- Conducts inpatient admission, concurrent, and retrospective review for Medicare and Medicaid beneficiaries as well as managed care and self-pay patients based on CMS guidelines.
- Uses national medical necessity tool to screen for appropriateness for inpatient level of care or observation services based on physician certification including history and physical, treatment plan, potential risks, and basis for expectation of a 2-midnight stay.
- Collaborates with physicians and APRNs to influence appropriate utilization of resources, accurate status determination, and transitions of care. Educates members of the patient’s care team on the appropriate access to and use of various levels of care.
- Promotes medical documentation that accurately reflects findings and interventions, presence of complications or comorbidities, quality and safety indicators, and patient’s need for continuing stay.
- Represents utilization management at various committees, professional organizations, and physician groups as needed.
- Graduate from school of nursing. BSN preferred.
- Licensed as Registered Nurse in State of Missouri.
- Three years clinical or managed care experience required. Knowledge of medical necessity guidelines preferred.
