Mid Level Utilization Review Specialist Jobs

INTRODUCTION

At Singing River Health System, caring isn’t just part of the job — it’s in our DNA. Whether we’re saving lives, supporting behind the scenes, or showing up for our community, we bring the energy, heart, and hustle every single day.

With pride, passion, and commitment, we will improve health and save lives in our community every day.

Shift:

Monday - Friday (8 hour shifts). May include rotating weekends.

Location:

Singing River Ocean Springs Hospital

JOB DESCRIPTION SUMMARY

POSITION OVERVIEW:

The Utilization Review (UR) Nurse is responsible for ensuring that patient care services meet established medical necessity criteria and align with appropriate levels of care. This role performs concurrent and retrospective reviews to evaluate the appropriateness, quality, and efficiency of care based on the patient’s clinical presentation and services ordered or provided.

Using established hospital approved level of care criteria and professional clinical judgment, the UR Nurse determines appropriate patient status and facilitates the use of the most suitable level of care. This role requires maintaining up-to-date knowledge of commercial and government payer requirements, as well as DNV regulations, guidelines, and criteria related to the Utilization Review process.

The UR Nurse practices in accordance with professional Standards of Nursing Practice under the leadership and direction of the Utilization Management Director. This position demands the ability to work effectively in high-pressure environments, manage multiple tasks simultaneously with minimal errors, and function independently with strong attention to detail.

DISCLAIMER: This is not necessarily an exhaustive list of all responsibilities, duties, skills, efforts, requirements or working conditions associated with the job. While this intends to be an accurate reflection of the current job, management reserves the right to revise the job or to require that other or different tasks performed as assigned.

Education:

Graduate from an accredited school of Nursing: Bachelor’s degree in nursing preferred.

LICENSE:

Currently licensed to practice as a Nurse in the State of Mississippi.

CERTIFICATIONS:

ACMA (American Case Management Association) or CCM (Certified Case Manager) certification preferred.

Must have de-escalation training completed by the end of position orientation (90 days); must have appropriate level of de-escalation training.

Experience:

Five (5) years’ acute care nursing and/or case management experience. Utilization or Case Management experience preferred.

REPORTS TO:

Director – Utilization Management

SUPERVISES:

None

PHYSICAL DEMANDS:

Work is moderately active: involves sitting with frequent requirements to move about the office, move about the facility, and to travel to another facility within the SRHS service area. Work involves exerting a negligible amount of force frequently to lift, carry, push, pull, or otherwise move objects, including the human body.

Work involves using many physical motions in performing daily work activities; subject to exposure of body fluids, sputum and tissues, which may carry the hazard of infectious disease. Work involves using repetitive motions: substantial movements of the wrists, hands, and or fingers while operating standard office equipment such as computer keyboard.

Work involves being able to perceive the nature of sound at normal speaking levels with or without correction; the ability to make fine discriminations in sound. Work requires close visual and acuity and the ability to adjust the eye to bring an object into sharp focus, i.e. shift gaze from viewing a computer monitor to forms/printed material that are closer to compare data at close vision.

Must be able to be active for extended periods of time without experiencing undue fatigue. Must be able to work schedules assigned with the understanding that changes may be instituted according to the needs of the hospital for off days, shifts or weekends.

MENTAL DEMANDS:

Must demonstrate keen mental faculties/assessment and decision making abilities. Must demonstrate superior communication/speaking/enunciation skills to receive and give information in person and by telephone. Must demonstrate strong written and verbal communication skills. Must possess emotional stability conducive to dealing with high stress levels. Must demonstrate ability to work under pressure and meet deadlines.

Attention to detail and the ability to multi-task in complex situations is required. Must have the ability to maintain collaborative and respectable working relationships throughout SRHS and other organizations.

SPECIAL DEMANDS:

Must possess superior customer service skills and professional etiquette. Must possess proficient knowledge and ability to use a computer (must be keyboard proficient) and other office technology (i.e., telephone, fax, etc.), MS Outlook and Word.

Must be able to demonstrate appropriate clinical judgment and apply appropriate professional skills to a patient population of all ages.

If you’re looking for purpose, teamwork, and a place where what you do truly matters, you’ve found it. Let’s do big things together. Apply now and join our team.