Utilization Review Nurse
Boost your chances before you apply.
CHI St. Vincent Health
Little Rock, AR, US
Summary
The Utilization Review Nurse ensures the medical necessity and efficiency of inpatient services by conducting chart reviews and applying clinical criteria. They act as a liaison between the clinical team and insurance providers to secure authorizations and prevent claim denials.
Job Description
Where You’ll Work
CHI St. Vincent, a regional health network serving Arkansas, is part of CommonSpirit Health. We have served Arkansas since 1888 with a history of many firsts. Together with more than 4500 coworkers, 1000 medical staff and 500 volunteers we consistently receive praise for care advancements. CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health in 2019. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community. CHI St. Vincent provides you with the same level of care you provide to others. We care about our team member well-being and offer benefits that complement and support your work/life balance.
Job Summary and Responsibilities
The Utilization Review Nurse is responsible for ensuring the medical necessity, appropriateness, and efficiency of inpatient hospital services. This role involves conducting concurrent and retrospective reviews of patient charts, applying standardized clinical criteria to validate admission status, and coordinating with insurance payers to secure timely authorizations. The UR Nurse serves as a vital liaison between the clinical care team and insurance providers to prevent claim denials, facilitate smooth transitions of care, and optimize hospital reimbursement.
He/she works collaboratively with physicians and other members of the health care team to ensure that the patient gets the right treatment from resources that are available in the hospital with the most cost effective use of available resources. Is held accountable for policies and procedures of the department and organization.
Job Requirements
Registered Nurse with Bachelor's degree or diploma/Associate's degree with Care Management certification within 2 years of hire date (CCM or ACM)
Bachelor’s Degree in Nursing (BSN)Minimum of four (4) years of experience as a RN
Requires Minimum of three years in acute care hospitalPreferred – experience in Case Management, discharge planning or utilization management role
CHI St. Vincent, a health system serving more than 1 million Arkansans a year, includes primary care, specialty clinics, urgent care, hospitals, home care and rehabilitation. Our coworkers and medical staff number more than 6,000. We are living our mission by providing high quality care, serving those most in need (part of our Catholic heritage) and creating healthier communities. We are not-for-profit and sponsored by the national Catholic Health Initiative (CHI) system.
Founded
1888
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Little Rock, Arkansas
CHI St. Vincent, a health system serving more than 1 million Arkansans a year, includes primary care, specialty clinics, urgent care, hospitals, home care and rehabilitation. Our coworkers and medical staff number more than 6,000. We are living our mission by providing high quality care, serving those most in need (part of our Catholic heritage) and creating healthier communities. We are not-for-profit and sponsored by the national Catholic Health Initiative (CHI) system.
Founded
1888
Company size
5,001-10,000 employees
Industry
Hospitals and Health Care
Org type
Nonprofit
Headquarters
Little Rock, Arkansas
