Registered Nurse – Utilization Review

Trinity Health

. Facilitate collection of patient clinical information and application of clinical criteria .

Posted 10/27/2026part-timeAnn Arbor • Michigan • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in utilization management and clinical documentation, ensuring compliance with standards and effective communication with interdisciplinary teams. Proficient in coordinating patient care processes and minimizing medical necessity denials through thorough clinical reviews.

Highest-signal resume keywords

Utilization ManagementClinical DocumentationRegistered Nurse LicensePatient Care CoordinationProcess Improvement

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Utilization ReviewClinical Criteria ApplicationPatient Demographic ManagementInsurance Clearance CoordinationElectronic Care Management DocumentationMedical Necessity ReviewConcurrent ReviewRetrospective ReviewPayer CommunicationClinical Assessment

Soft Skills

CollaborationCommunicationProblem-SolvingInterpersonal SkillsOrganizational Skills

Tools & Technologies

Electronic Health Record SystemsCare Management Software

Certifications & Qualifications

Registered Nurse (RN) LicenseBachelor of Science in Nursing (BSN)

Industry Keywords

Patient AccessRevenue Cycle ManagementManaged CareMedicaidMedicare

About the role

Key responsibilities & impact

Facilitate collection of patient clinical information and application of clinical criteria
Facilitate utilization management documentation and appropriate communication with external agencies
Work two shifts every other weekend with approximately one holiday commitment every 18 months
Work eight-hour shifts, generally starting between 6 a.m. and 9 a.m.
Complete utilization review documentation for concurrent and retrospective patients within established timelines
Ensure authorizations are obtained and communicated to ePFS teams
Identify and resolve errors related to patient demographic and insurance information
Coordinate with Revenue Cycle departments such as Insurance Clearance
Submit utilization review documentation for Commercial, Managed Medicare, and Medicaid payer reviews
Document clinical review dates and authorizations in the electronic care management module
Communicate with case managers and physician advisors
Coordinate the peer-to-peer concurrent appeal process
Coordinate telephone appointments with payer Medical Directors and document outcomes electronically
Minimize medical necessity denials caused by insufficient clinical review information
Maintain collaborative relationships with Care Management, Physician Advisors, ePFS, Patient Access, Health Information Management, Insurance Clearance, and Patient Accounting departments
Identify process improvement opportunities
Document assessments, interventions, transitions, and outcomes according to applicable standards, policies, procedures, and guidelines

Requirements

What you’ll need

Graduation from an accredited nursing program
All new hires effective January 1, 2013 must have a BSN degree or agree in writing to obtain a BSN within five years from date of hire
Two to three years of related experience and clinically relevant knowledge regarding the patient population
Current Registered Nurse license in the State of Michigan (RN)

Benefits

Comp & perks

Contingent position with weekday and weekend coverage
Flexible start times
Additional hours available