UTILIZATION REVIEW NURSE (RN) - TEAM LEAD

We need to output HTML fragment with sections: headings

for sections like About the role, Responsibilities, Requirements, Qualifications, Skills, Benefits, Pay, Schedule. Only include sections that have real specific content. We must not repeat job title as heading. No Job ID etc. Remove boilerplate. Must preserve all substantive info. Let's parse the posting. Content: - Location: Premier Health – SYSTEM SUPPORT 110 N MAIN ST, DAYTON, 45402 DEPT: CENTER FOR STATUS INTEGRITY Full-Time / Day Shift / 7:00 am - 4:30 pm - Intro paragraph: "If you’re an experienced utilization review nurse looking for the next step in your career, this is an opportunity to lead meaningful work that directly impacts patient care, regulatory excellence, and organizational performance. In this role, you’ll have the chance to combine your clinical expertise with leadership responsibilities, helping guide a team, support sound admission status decisions, prevent avoidable denials, and improve patient throughput. For professionals motivated by influence, collaboration, and the ability to make a measurable difference, this position offers both purpose and professional growth. Premier Health offers the opportunity to work in a highly collaborative environment where your voice and experience matter." - Then description of role: "As the Utilization Review Nurse - Team Lead, you will serve as both a clinical expert and an operational leader, supporting staff development, mentoring team members, and partnering closely with physicians, case management, CDI, coding, and revenue cycle teams. This role is ideal for a nurse who values teamwork, process improvement, and the opportunity to shape outcomes across the continuum of care." - Then about Premier Health: "Premier Health has built a strong reputation as a respected healthcare employer, known for its commitment to quality, patient-centered care, and professional excellence. Team members are valued for their expertise and dedication, and leaders are empowered to contribute to a culture of accountability, support, and continuous improvement. In this role, you will feel connected not only to your immediate team, but also to the broader mission of delivering the right care at the right time while maintaining compliance and optimizing reimbursement. Employees in healthcare leadership and clinical support roles often value the sense of purpose, collaboration, and trust they experience when working with a strong interdisciplinary team. In this position, you’ll be part of a professional environment where relationships matter, expertise is respected, and your leadership helps others succeed. If you enjoy mentoring peers, solving complex utilization challenges, and driving best practices in regulatory compliance and denial prevention, this role can offer a highly rewarding next step." - Then detailed responsibilities: "The Utilization Review Nurse Team Lead serves as the clinical and operational leader for the UR team, ensuring appropriate patient status, medical necessity compliance, denial prevention, and regulatory adherence while supporting staff development and performance. The UR Nurse Team Lead provides day-to-day oversight of utilization review activities, including medical necessity reviews, admission status determinations, payer communications, denial management, and regulatory compliance. The Team Lead acts as a clinical resource for staff, collaborates with physicians, case management, CDI, Coding, and revenue cycle teams, and promotes efficient patient throughput while optimizing reimbursement and reducing avoidable denials. Serves as the primary review resource for UR nurses Assists with orientation and mentoring of new staffAssist manager with staffing, scheduling, and workload distributionAssists with facilitating team huddles and with staff meetingsProvide guidance on admission status determinationAssist staff with complex medical reviews using CMS and payer-specific criteriaSupport escalation of cases to the physician advisor teamMonitor compliance with the Two-Midnight rule and payer-specific requirementsIdentify trends leading to medical necessity and level of care denialsCollaborate with physician advisors and revenue cycle teams to reduce denialsParticipate in denial reviews and appeal preparationParticipate in regular audits of UR staff for accuracy of status assignment, clinical review integrity, and productivityParticipate in denial data entry and collectionEnsure compliance with CMS regulations, Medicare Conditions of Participation, commercial payer requirements, and state and accreditation standardsSupport audit readiness and regulatory reviewsTrack key performance indicators including initial review timeliness, continued stay review compliance, observation to inpatient conversion rates, and denial ratesLead or participate in performance improvement initiatives focused on throughput, status accuracy, and denial reduction" - Then note: "Note: Local Candidates preferred - must be willing to commute and work "in-person" often at the Dayton, Ohio area offices Preferred candidates will live within 60 miles driving distance to Dayton, Ohio Bachelor’s degree requiredValid RN license in the State of Ohio required3–5 years of job-related experience requiredPrevious experience as a Utilization Review Nurse requiredCertification in a clinical specialty such as case management, utilization review, critical care, or rehab preferredExemplary interpersonal skills with the ability to build and maintain rapport with physicians and Integrative Care Team membersStrong negotiation, conflict resolution, and assertive communication skillsKnowledge of InterQual ISD-A and Milliman Guidelines preferredKnowledge of third-party insurance requirements preferredProficiency in Microsoft Office required" - Then final paragraph: "If you are ready to bring your utilization review expertise and leadership abilities to an organization that values collaboration, clinical excellence, and continuous improvement, consider joining Premier Health as a Utilization Review Nurse Team Lead. This is your opportunity to influence outcomes, support a high-performing team, and contribute to exceptional patient care across Ohio. Apply now to take the next step in your nursing leadership career." We need to remove application instructions: "Apply now to take the next step..." is application instruction? Probably yes, we should remove that line. Also "Apply now" is instruction. Remove that sentence. Also remove any boilerplate like EEO etc. Not present. We need to decide sections. We have location and schedule info: "Full-Time / Day Shift / 7:00 am - 4:30 pm". That's schedule. So we can have a Schedule section with that. Pay: Not mentioned. So no Pay section. Benefits: Not mentioned. So no Benefits. About the role: Could be the introductory paragraphs describing role and purpose. Responsibilities: The detailed list of duties. Requirements: Education, licensure, experience, maybe location preference. Qualifications: Could be certifications, skills, knowledge. Skills: Interpersonal, negotiation, communication, proficiency in MS Office, knowledge of guidelines. We need to avoid duplication. Let's extract. First, location: "Premier Health – SYSTEM SUPPORT 110 N MAIN ST, DAYTON, 45402 DEPT: CENTER FOR STATUS INTEGRITY". Could be included in a short paragraph maybe under About the role or separate? Not a heading. We'll embed in a paragraph. Schedule: "Full-Time / Day Shift / 7:00 am - 4:30 pm". We'll put under Schedule section. Now About the role: combine the introductory paragraphs that describe the role, purpose, environment. Let's craft a paragraph. Responsibilities: list bullet points from the detailed responsibilities. Requirements: Bachelor’s degree required, Valid RN license in Ohio required, 3–5 years of job-related experience required, Previous experience as a Utilization Review Nurse required, Local Candidates preferred (must be willing to commute and work in-person often at Dayton, Ohio area offices), Preferred candidates will live within 60 miles driving distance to Dayton, Ohio. Qualifications: Certification in a clinical specialty such as case management, utilization review, critical care, or rehab preferred. Skills: Exemplary interpersonal skills with ability to build/maintain rapport with physicians and Integrative Care Team members, Strong negotiation, conflict resolution, and assertive communication skills, Knowledge of InterQual ISD-A and Milliman Guidelines preferred, Knowledge of third-party insurance requirements preferred, Proficiency in Microsoft Office required. We might also include "Lead or participate in performance improvement initiatives" as responsibility. Let's ensure we don't repeat. Now produce HTML:

About the role

... paragraph ...

Responsibilities

• ...
...

Requirements

• Bachelor’s degree required
• Valid RN license in the State of Ohio required
• 3–5 years of job‑related experience required
• Previous experience as a Utilization Review Nurse required
• Local candidates preferred – must be willing to commute and work in‑person often at the Dayton, Ohio area offices
• Preferred candidates will live within 60 miles driving distance to Dayton, Ohio

Qualifications

• Certification in a clinical specialty such as case management, utilization review, critical care, or rehab preferred

Skills

• Exemplary interpersonal skills with the ability to build and maintain rapport with physicians and Integrative Care Team members
• Strong negotiation, conflict resolution, and assertive communication skills
• Knowledge of InterQual ISD‑A and Milliman Guidelines preferred
• Knowledge of third‑party insurance requirements preferred
• Proficiency in Microsoft Office required

Schedule

Full‑Time / Day Shift / 7:00 am – 4:30 pm

We might also include location in About the role paragraph. Let's craft About the role paragraph: Premier Health – SYSTEM SUPPORT, 110 N Main St, Dayton, OH 45402, Department of Center for Status Integrity. This full‑time day‑shift position (7:00 am – 4:30 pm) seeks an experienced utilization review nurse to lead meaningful work that impacts patient care, regulatory excellence, and organizational performance. The role combines clinical expertise with leadership responsibilities, guiding a team, supporting sound admission status decisions, preventing avoidable denials, and improving patient throughput. Premier Health offers a highly collaborative environment where your voice and experience matter, and you will serve as both a clinical expert and operational leader for the Utilization Review team, mentoring staff, partnering with physicians, case management, CDI, coding, and revenue cycle teams, and contributing to a culture of accountability, support, and continuous improvement. That seems good. Now responsibilities list: need to capture all duties from the detailed responsibilities paragraph. Let's extract bullet points: - Serves as the clinical and operational leader for the UR team, ensuring appropriate patient status, medical necessity compliance, denial prevention, and regulatory adherence while supporting staff development and performance. - Provides day-to-day oversight of utilization review activities, including medical necessity reviews, admission status determinations, payer communications, denial management, and regulatory compliance. - Acts as a clinical resource for staff. - Collaborates with physicians, case management, CDI, Coding, and revenue cycle teams. - Promotes efficient patient throughput while optimizing reimbursement and reducing avoidable denials. - Serves as the primary review resource for UR nurses. - Assists with orientation and mentoring of new staff. - Assists manager with staffing, scheduling, and workload distribution. - Assists with facilitating team huddles and staff meetings. - Provides guidance on admission status determination. - Assists staff with complex medical reviews using CMS and payer-specific criteria. - Supports escalation of cases to the physician advisor team. - Monitors compliance with the Two-Midnight rule and payer-specific requirements. - Identifies trends leading to medical necessity and level of care denials. - Collaborates with physician advisors and revenue cycle teams to reduce denials. - Participates in denial reviews and appeal preparation. - Participates in regular audits of UR staff for accuracy of status assignment, clinical review integrity, and productivity. - Participates in denial data entry and collection. - Ensures compliance with CMS regulations, Medicare Conditions of Participation, commercial payer requirements, and state and accreditation standards. - Supports audit readiness and regulatory reviews. - Tracks key performance indicators including initial review timeliness, continued stay review compliance, observation to inpatient conversion rates, and denial rates. - Leads or participates in performance improvement initiatives focused on throughput, status accuracy, and denial reduction. We can combine some similar points but keep substantive. Now Requirements list: we already have. Qualifications list: certification preferred.