The Staff Pad is proud to partner with St. Peter’s Health in Helena, Montana, in the search for a qualified and detail-oriented Utilization Management Nurse. This is an impactful opportunity to join a respected healthcare organization focused on delivering efficient, compliant, and cost-effective care. Key Responsibilities: Monitor patient care from ED admission through discharge to ensure compliance with utilization guidelines Investigate, respond to, and resolve insurance denials and appeals Collaborate with healthcare teams to confirm admission status, diagnosis, and treatment plan milestones Conduct medical record reviews for prior authorization, medical necessity, and level of care determination using InterQual or MCG guidelines Communicate directly with providers to obtain necessary clinical documentation Track appeal submissions and outcomes; coordinate peer-to-peer reviews with insurance providers Educate staff on utilization trends, policy changes, and process improvements Maintain accurate documentation of all utilization and authorization activities Promote adherence to quality standards and regulatory compliance Qualifications: Experience: Minimum 3 years in acute care; background in utilization management or healthcare insurance required Education: LPN or RN; clinical preparation essential Licensure: Current nursing license in the State of Montana Preferred Certifications: Case Management and/or Utilization Review certification Technical Skills: Proficiency in Word, Excel, and Meditech preferred Ideal Candidate Traits: Excellent interpersonal, communication, and negotiation skills Strong organizational abilities and independent work ethic Up-to-date knowledge of payer policies, regulatory guidelines, and best practices in utilization management Compassionate, collaborative, and solutions-driven in navigating complex care coordination
Back to searchUtilization Review RN
The Staff Pad
Posted 19 days ago, valid for a month
Helena, MT 59604, US
$60,000 - $72,000 per year
Full Time
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Sonic Summary
- St. Peter’s Health in Helena, Montana, is seeking a qualified Utilization Management Nurse with a minimum of 3 years of experience in acute care and a background in utilization management or healthcare insurance.
- The position involves overseeing utilization functions, ensuring patients receive appropriate care, and maintaining documentation integrity.
- Key responsibilities include monitoring patient care, resolving insurance denials, collaborating with healthcare teams, and educating staff on utilization trends.
- Candidates must hold a current nursing license in Montana, with preferred certifications in Case Management and/or Utilization Review.
- The salary for this role is competitive, reflecting the importance of the position within the healthcare organization.
Position Overview:
As a Utilization Management Nurse, you will support the Utilization Review RN Coordinator by overseeing and managing utilization functions across the organization. Your role is essential in ensuring that patients receive medically appropriate care while maintaining documentation integrity and reimbursement accuracy. You will act as a liaison among insurance providers, healthcare teams, and hospital departments, advocating for both patient needs and institutional best practices.
