RN Utilization Review Case Manager

Utilization Review Specialist RNFull-Time | Case Management | Gateway Regional Medical Center | Granite City, IllinoisGateway Regional Medical Center is hiring a Utilization Review Specialist Registered Nurse (RN) to join our Case Management team.This role is ideal for an experienced acute care nurse who is ready to move into a more analytical, process-driven role focused on appropriate utilization of services, payer compliance, and supporting high-quality, cost-effective patient care.What You'll DoIn this role, you will support appropriate patient care utilization and financial stewardship by:Completing admission and concurrent chart reviews for medical necessityWorking to prevent denials from all payers through timely review and documentationManaging and coordinating appeals for denied or at-risk accountsCollaborating with physicians, case managers, and interdisciplinary teamsMonitoring payer requirements and regulatory compliance standardsIdentifying denial trends and opportunities for process improvementSupporting efficient patient flow and appropriate level-of-care placementEnsuring accurate and timely documentation to support reimbursementWhat We're Looking ForGraduate of an accredited School of Nursing (RN required)Current Illinois RN licenseCurrent BLS certification requiredMinimum 5 years of acute care clinical nursing experience requiredExperience in case management, discharge planning, utilization review, or appeals preferredFamiliarity with InterQual and/or Milliman criteria preferredIdeal CandidateThis role is a great fit if you:Have strong critical thinking and clinical judgment skillsEnjoy reviewing clinical documentation and problem-solvingAre detail-oriented and comfortable working with payer guidelinesThrive in a structured, policy-driven environmentWant to transition out of bedside nursing into a more administrative clinical roleWhy Join Gateway?Competitive pay: $32.00–$48.00/hrComprehensive medical, dental, and vision insurancePaid vacation and holiday timeRetirement plan with employer matchStable weekday schedule (no nights or weekends, if applicable you can insert)Supportive case management and interdisciplinary team environmentOpportunity to directly impact quality metrics and hospital performanceLocationGateway Regional Medical Center2100 Madison AveGranite City, IL 62040CompensationCompensation is based on education, experience, certifications, and relevant skills. Final offers are determined through our compensation review process to ensure fairness and internal equity.Join a team where your clinical expertise helps ensure patients receive the right level of care at the right time-while supporting quality, compliance, and patient outcomes. Apply today.