Utilization Management RN - Care Continuity - UH Truman Medical Centers (5 days per week; 7:00a-4:00p; Mon-Fri)

Job Description

Optimize Care. Improve Outcomes. Elevate the Patient Experience.

Are you a skilled RN with a passion for driving quality care while maximizing resource efficiency? Join our dedicated Utilization Management team and help shape smarter, more effective care delivery across the healthcare continuum. As a UM Nurse, you’ll play a critical role in supporting interdisciplinary collaboration, resource stewardship, and positive patient outcomes. You'll serve as a clinical advisor, problem solver, and resource utilization expert for our care teams.

What You’ll Do

• Partner with interdisciplinary teams to ensure effective and efficient use of healthcare resources.
• Monitor patient care delivery to align with best practices, regulatory standards, and financial goals.
• Serve as an internal consultant to clinical staff, providing guidance on utilization practices, clinical documentation, and discharge planning.
• Leverage data and clinical judgment to support timely transitions of care and optimize care coordination.
• Participate in quality and performance improvement initiatives focused on resource utilization and patient-centered care.

Minimum Requirements

• BSN preferred (or graduate degree in Nursing if BSN not held)
• Active RN license in the state of Missouri
• 2 years of clinical experience in an acute hospital setting
• Proficiency with Windows-based programs and electronic health records
• Strong verbal, written, and interpersonal communication skills
• Excellent critical thinking, problem-solving, and organizational skills
• Ability to thrive in a fast-paced, team-oriented environment

Preferred Qualifications

• Previous Utilization Management experience
• Familiarity with managed care, TJC, CMS standards, and performance improvement
• Knowledge of ICD/CPT/DRG coding systems
• Behavioral Health experience
• Experience analyzing data or working with utilization metrics
• National certification in Utilization Management or Case Management (e.g., ACM, CCM, or CMAC)