Utilization Review, Registered Nurse – Weekend

Mosaic Life Care

. Perform inpatient admission, concurrent, and retrospective reviews for Medicare, Medicaid, managed care, and self-pay patients using CMS guidelines .

Posted 9/23/2026full-timeSaint Joseph • Missouri • United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in inpatient admission reviews, medical necessity guidelines, and regulatory compliance while effectively collaborating with healthcare teams to optimize patient care and resource utilization.

Highest-signal resume keywords

Registered Nurse (RN) LicensureClinical or Managed Care ExperienceMedical Necessity Guidelines KnowledgeCritical Thinking and Problem-SolvingEffective Communication Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Inpatient Admission ReviewsConcurrent and Retrospective ReviewsResource Utilization AssessmentMedical DocumentationDenial Coordination

Soft Skills

LeadershipTeaching AbilityMotivational SkillsNegotiation SkillsProfessional Demeanor

Tools & Technologies

National Medical Necessity ToolVoice RecorderComputer Skills

Certifications & Qualifications

Bachelor of Science in Nursing (BSN)State Licensure in Missouri

Industry Keywords

MedicareMedicaidManaged CareAcute-Care DeliveryPatient Flow Barriers

About the role

Key responsibilities & impact

Perform inpatient admission, concurrent, and retrospective reviews for Medicare, Medicaid, managed care, and self-pay patients using CMS guidelines
Use a national medical necessity tool to assess inpatient-level-of-care or observation appropriateness
Stay current on regulatory changes affecting acute-care delivery or reimbursement
Identify and record progression-of-care and patient-flow barriers and communicate denial-of-stay information to the care team
Collaborate with physicians and APRNs on resource utilization, status determination, and transitions of care
Educate patient-care teams on access to and use of various levels of care
Represent utilization management at committees, professional organizations, and physician groups
Promote accurate medical documentation of findings, interventions, complications, comorbidities, quality and safety indicators, and continuing-stay needs
Confer with attending physicians and the Physician Advisor regarding medically unnecessary inpatient treatment
Coordinate appeals of denials
Serve as a resource for physicians, nurses, billing office, and external departments on coverage and compliance issues
Participate in program development and process improvement efforts
Perform other duties as assigned

Requirements

What you’ll need

Graduate from school of nursing with a bachelor's degree — required
Bachelor of Science in Nursing (BSN) — preferred
3 years of clinical or managed care experience — required
Knowledge of medical necessity guidelines — preferred
Registered Nurse (RN) state licensure or compact state licensure, licensed in Missouri — required upon hire
Hand/eye coordination, clear speech, good hearing, computer, telephone, and voice recorder skills
Ability to read, write, and speak clearly
Ability to teach, provide accurate and concise information, answer questions, demonstrate leadership, maintain positive relationships, motivate, and persuade others
Critical thinking, problem-solving, and negotiating abilities
Ability to determine appropriate responses to emergency situations
Ability to focus and concentrate despite distractions and interruptions
Ability to maintain a professional demeanor when communicating with patients, customers, and team members
Functional vision and hearing acuity
Must be able to travel between various system facilities and off-site locations as needed

Benefits

Comp & perks

Concierge services
Employee lounge
Wellness programs
Free covered parking
Free on-site and virtual health clinics
Compensation and recognition