About this opportunity
Gateway Regional Medical Center, Inc. lists this RN Utilization Review Case Manager opportunity in granite city, Illinois. Review the employer’s description below for duties, qualifications and application requirements.
Job description
We are Gateway Regional Medical Center
Our mission is to provide compassionate, high-quality healthcare services to our community, promoting wellness and healing through innovative treatments, advanced technology, and a dedicated team of professionals. We are committed to fostering a culture of respect, integrity, and excellence, ensuring that every patient receives personalized care in a safe and nurturing environment. Together, we strive to enhance the health and well‑being of those we serve and to be a trusted partner in their journey to better health.
Position Overview
The Utilization Review Specialist RN assumes responsibility and accountability for admission and concurrent reviews to ensure the prevention of denials from all payers, as well as coordination and management of appeals for accounts deemed appropriate for appeal. This role supports compliance with payer, regulatory, and accreditation standards while promoting efficient utilization of healthcare resources and quality patient outcomes. The Specialist works collaboratively with interdisciplinary teams to identify denial trends, improve workflows, and ensure timely resolution of utilization review and appeals processes.
Specifics
Position: Utilization Review Specialist RN
Department: Case management
Location: Gateway Regional Medical Center, 2100 Madison Ave., Granite City, IL 62040
Position Status: Full‑time
Education Qualifications
Graduate of an Accredited School of Professional Nursing
Certification Qualifications
Current Illinois Nursing License
Current Basic Life Support (AHA or American Red Cross BLS) certification
Preferred: Knowledge of InterQual and/or Milliman criteria
Experience Qualifications
Minimum of five years of clinical nursing experience in an acute care setting required.
Experience in case management, discharge planning, utilization review, or appeals management preferred.
Company Benefits
Competitive salary and performance‑based incentives
Comprehensive health, dental, and vision insurance plans
Retirement savings plan with employer matching
Vacation time and holiday pay
Supportive and inclusive work environment
Pay Range
The pay range for this position is $32.00 - 48.00 per hour.
Disclaimer: Pay is determined based on various factors, including education level, years of experience, relevant certifications, and specific skills related to the position. The final compensation package will be discussed with Human Resources to ensure fairness and alignment with the candidate's qualifications.
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Worksite address
granite city, IL, 62040, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.