RN Case Manager Utilization Review

SCL Health
Billings, MT
Post Date:
September 14, 2021
Job Status:

To show our commitment to your transition into our organization, we are offering up to $4000 in relocation.   



You bring your body, mind, heart and spirit to your work as an Utilization Review RN








St. Vincent Healthcare is part of SCL Health, a faith-based, nonprofit healthcare organization that focuses on person-centered care. Our 286-bed level II trauma center has provided care in Montana and the surrounding area since 1898, and our 30-clinic network ensures community needs are met. We offer comprehensive, specialty care, including a hospital within a hospital specifically for children, and are proud to extend SCL Healths missions by treating the poor, the vulnerable, our community and each other.




Benefits are one of the ways we encourage health for you and your family. Our generous package includes medical, dental and vision coverage. But health is more than a well-working body: it encompasses body, mind and social well-being. To that end, weve launched a Healthy Living program to address your holistic health. Healthy Living includes financial incentives, digital tools, tobacco cessation, classes, counseling and paid time off. We also offer financial wellness tools and retirement planning.






Together well align mission and careers, values and workplace.


Well encourage joy and take pride in our integrity.


Were proud of what we know, which includes how much there is to learn.




Your day.


As a Utilization Review RN, you need to know how to:







  • Uses nationally recognized review criteria to ensure that patient status is at the appropriate level of care.  Collaborates with physicians and care managers to support an appropriate and timely patient discharge.

  • Understands CMS medical necessity requirements and the coordination of care required under Federal and State regulations.  

  • Performs initial review and authorizations for admission.  Performs concurrent reviews to ensure that extended stays are medically necessary and justification is documented in the medical record.  Performs ongoing review of precertification and retrospective review for medical necessity.  Participates in continued stay reviews.  Communicates with attending physician regarding questions about continued length of stay, plan of care/discharge, and physician orders.

  • Refers appropriate cases to the designated Physician Advisor in accordance with established guidelines for admission status or continued stay.

  • Collaborates with case managers, physicians, and payers related to status, coverage, benefits, and discharge planning as needed.

  • Reviews medical records and prepares for appropriate clinical appeals.

  • Identifies opportunities for physician education regarding length of stay, resource utilization and clinical documentation related to justification for hospital services.





Your experience.


We hire people, not resumes. But we also expect excellence, which is why we require:



  • Graduate of an accredited school of nursing is required. BSN may be required for some Care sites

  • Current valid State RN License is required.

  • Three (3) years case management experience required. 


Your next move.


Now that you know more about being an Utilization Review RN on our team we hope youll join us. At SCL Health youll reaffirm every day how much you love this work, and why you were called to it in the first place.








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