Utilization Management Specialist

Logan Health

. Review all daily inpatient and observation admissions across the Logan Health system .

Posted 10/22/2026full-timeRemote • Montana • United StatesMid-LevelSenior💰 $38 - $54 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in inpatient utilization management, including evaluation of physician documentation and patient data, while ensuring compliance with Medicare and Medicaid regulations. Strong communication and collaboration skills are essential for effective interaction with interdisciplinary teams and stakeholders.

Highest-signal resume keywords

Montana RN LicenseInpatient Utilization Review ExperienceCCM CertificationMedicare and Medicaid Regulations KnowledgeAnalytical Thinking

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ManagementPatient Status EvaluationConcurrent and Retrospective ReviewsDocumentation ReviewQuality and Risk Management

Soft Skills

Excellent Interpersonal SkillsEffective Communication SkillsTact and ProfessionalismAnalytical Thinking

Tools & Technologies

Electronic Medical Records

Certifications & Qualifications

CCM Certification

Industry Keywords

Acute Care Hospital ExperienceDenial ManagementMedicare Inpatient Only ListRACQIOMAC

About the role

Key responsibilities & impact

Review all daily inpatient and observation admissions across the Logan Health system
Evaluate physician documentation and patient data to determine appropriate admission status
Reassess patients throughout their stay to ensure continued criteria for level of care are met
Collaborate with the physician UM Advisor, case management team, and insurance partners to facilitate authorizations and medical necessity reviews
Assist with scheduling and coordinating peer-to-peer physician reviews
Communicate with providers, nurses, and other stakeholders to ensure accurate documentation and smooth care transitions
Identify and address issues that could delay reviews or affect compliance
Utilize electronic medical records for documentation, review, and reporting
Coordinate and facilitate correct identification of patient status using validated criteria
Complete short stay work queue reviews and track and trend results for reporting and education
Identify process and system improvement opportunities and lead performance initiatives
Identify and resolve system process issues, delays, and obstacles affecting utilization management
Answer clinical questions related to medical necessity and patient status
Perform concurrent and retrospective reviews
Assist with insurance denial appeal letters, audit activities, and payer inquiries
Resolve utilization management and patient status issues with stakeholders
Consult appropriate disciplines and departments to expedite care and facilitate accurate documentation
Refer utilization management issues to leadership or appropriate stakeholders and monitor resolution
Participate in development, implementation, teaching, evaluation, and revision of departmental utilization management standards
Participate in orientation of new department staff
Document utilization management, quality, and risk concerns and refer them for follow-up
Work independently while collaborating with the interdisciplinary team

Requirements

What you’ll need

Current Montana RN License or a multi state compact license with authorization to practice nursing within the state of Montana
Bachelor’s degree in Social Work
Associate’s degree required; Bachelor’s degree preferred
Minimum of five (5) years’ acute care hospital experience required
CCM Certification preferred
Prior experience as an inpatient utilization review nurse or UM specialist preferred
Knowledge in areas of Medicare and Medicaid UM regulations, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management preferred
Excellent interpersonal skills with the ability to manage sensitive and confidential situations with tact, professionalism, and diplomacy
Excellent verbal and written communication skills including the ability to communicate effectively with various audiences
Strong computer literacy
Analytical thinking
Acute care (hospital) experience
Must currently reside in the State of Montana
Must pass pre-employment criminal background, reference, drug, health and immunizations, and physical demand screenings

Benefits

Comp & perks

Four day work week
Affordable Medical Benefits package
401(k) with generous immediate employer match
Logan Health Fitness Center Membership Discount!
A supportive, mission-driven nursing culture focused on quality, compassion and person-centered care!