RN Utilization Review Case Manager

Utilization Review Specialist RN

Full-Time | Case Management | Gateway Regional Medical Center | Granite City, Illinois

Gateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.

This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.

What You'll Do

In this role, you will support appropriate patient care utilization and financial stewardship by:

• Completing admission and concurrent chart reviews for medical necessity
• Working to prevent denials from all payers through timely review and documentation
• Managing and coordinating appeals for denied or at-risk accounts
• Collaborating with physicians, case managers, and interdisciplinary teams
• Monitoring payer requirements and regulatory compliance standards
• Identifying denial trends and opportunities for process improvement
• Supporting efficient patient flow and appropriate level-of-care placement
• Ensuring accurate and timely documentation to support reimbursement

What We're Looking For

• Graduate of an accredited School of Nursing (RN required)
• Current Illinois RN license
• Current BLS certification required
• Minimum 5 years of acute care clinical nursing experience required
• Experience in case management, discharge planning, utilization review, or appeals preferred
• Familiarity with InterQual and/or Milliman criteria preferred

Ideal Candidate

This role is a great fit if you:

• Have strong critical thinking and clinical judgment skills
• Enjoy reviewing clinical documentation and problem-solving
• Are detail-oriented and comfortable working with payer guidelines
• Thrive in a structured, policy-driven environment
• Want to transition out of bedside nursing into a more administrative clinical role

Why Join Gateway?

• Competitive pay: $32.00-$48.00/hr
• Comprehensive medical, dental, and vision insurance
• Paid vacation and holiday time
• Retirement plan with employer match
• Stable weekday schedule (no nights or weekends, if applicable you can insert)
• Supportive case management and interdisciplinary team environment
• Opportunity to directly impact quality metrics and hospital performance

Location

Gateway Regional Medical Center
2100 Madison Ave
Granite City, IL 62040

Compensation

Compensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.

Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time-while supporting quality, compliance, and patient outcomes. Apply today.