Hennepin Healthcare
Location
Minneapolis, Minnesota
The Utilization Review Registered Nurse evaluates the medical necessity, appropriateness, and efficiency of healthcare services using established criteria like InterQual. This role collaborates with clinical teams, payers, and patients to optimize resource utilization and ensure quality care progression.
Candidates must possess a valid Minnesota Registered Nurse license and have at least one year of Utilization Review experience. Additionally, a minimum of two years of recent acute care nursing experience is required to ensure independent clinical judgment.
Reviews patient records to perform utilization review and verify patient status. Apply nationally recognized criteria (e.g., lnterQual) to assess the appropriateness of services.
Coordinates with clinical teams, payers, and discharge planners to support timely care progression and appropriate resource use.
Follows the established UR workflows and UR Plan. Implements review processes to evaluate necessity and efficiency of services. Initiates communication with physicians and payers to resolve authorization issues and prevent delays in care.
Collaborates with nursing, providers, case management, finance, and payer representatives. Contributes to professional development by sharing knowledge and supporting team education.
As of March 1, 2026, the following are required for new hires or existing employees that would move into this role: A minimum of one (1) year of Utilization Review experience is required, with at least one year occurring within the past 12 months preferred At least two (2) years of recent acute care nursing experience (med/surg, ICU, ED, etc.) required to ensure independent clinical judgement OR an approved equivalent combination of education and experience
BSN preferred and strongly encouraged ACM or CCM certification preferred Strong understanding of utilization review/utilization management principles Familiarity with lnterQual, MCG, or similar clinical decision-making tools License/Certifications: Possession of a valid license as a Registered Nurse issued by the State of Minnesota.
Staff Nurse (RN) - Inpatient Psychiatry
Staff Nurse (RN) - Inpatient Psychiatry
Case Management Assistant
Case Management Assistant
Medical Assistant (0.8 FTE) - Mobile Clinic (grant-funded)
Medical Assistant (0.8 FTE) - Mobile Clinic (grant-funded)
IRTS Behavioral Health Practitioner II/Mental Health Counselor
RN Operating Room
Inpatient Hematology/Oncology Physician Assistant or Nurse Practitioner
Therapist
Psychiatric Mental Health Nurse Practitioner (PMHNP)
Pre-Licensed Psychotherapist