Utilization Review Nurse - RN

About the role

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.

Responsibilities

• Ensure patient care services meet established medical necessity criteria and align with appropriate levels of care.
• Perform concurrent and retrospective reviews to evaluate appropriateness, quality, and efficiency of care based on the patient’s clinical presentation and services ordered or provided.
• Use hospital‑approved level of care criteria and professional clinical judgment to determine appropriate patient status and facilitate the most suitable level of care.
• Maintain up‑to‑date knowledge of commercial and government payer requirements, as well as DNV regulations, guidelines, and criteria related to the Utilization Review process.
• Practice in accordance with professional Standards of Nursing Practice under the leadership of the Utilization Management Director.
• Work effectively in high‑pressure environments, manage multiple tasks simultaneously with minimal errors, and function independently with strong attention to detail.

Requirements

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

Qualifications

• Certifications: ACMA (American Case Management Association) or CCM (Certified Case Manager) certification preferred