RN / Registered Nurse - Utilization Management - ...

ProMedica Monroe Regional Hospital offers a broad range of inpatient and outpatient services in southern Michigan and Ohio. A national leader in treatment of heart attack, congestive heart failure, pneumonia and surgical care, ProMedica Monroe Regional Hospital is also a pacesetter in Michigan for obstetrics, emergency care, intensive care, controlling infections and organ donation.Position SummaryConduct concurrent medical record review for medical necessity and level of care using nationally recognized acute care indicators and criteria as approved by medical staff, Joint commission, CMS and other state agencies. Prospectively or concurrently determines the appropriateness of inpatient or observation services following review of medical documentation, medical guidelines and insurance benefits and communicates information to payers in accordance with contractual obligation.Job Requirements* Graduate of a professional school of nursing with licensure as an RN in the State of Michigan.* At least 5 years of clinical experience, Psychiatric Nursing preferred.* Case Management or Insurance Verification experience preferred.* Superior skills in clinical judgement, organization and self motivated.* Bachelor''s degree preferred.ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact [Click Here to Email Your Resumé]Equal Opportunity Employer/Drug-Free WorkplaceEmployee Exemption TypeNon-ExemptJob TypeCONTINGENTBudgeted Hours / Pay Period0Shift TypeDaysShift HoursWeekendsOn-call RequirementsAdditional Schedule DetailsUtilization Review in the Inpatient Psych unit at Monroe Hospital.

Created: 2025-11-15