Behavioral Health Utilization Lead

Duke Careers; Durham (NC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Relocation Assistance

Job summary

Duke Regional Hospital in Durham, North Carolina, is seeking a Utilization Manager / Medical Chart Auditor to ensure medical necessity and accurate patient status determinations across ED and inpatient services. The role supports denials management, discharge planning, and cost-effective care in a collaborative clinical setting.

BSN and Case Management Certification within 2 years are required, with a minimum of three years of acute clinical experience.

Qualifications

• BSN required and NC RN licensure.
• Case Management Certification (ACM/CCM/ANCC) within 2 years of hire.
• Minimum of three years acute clinical practice or related health care experience.
• Proficiency in electronic health records and clinical documentation.

Responsibilities

• Validate patient status and medical necessity for bedded patients.
• Manage concurrent cases to resolution of care impacting payer approval.
• Conduct initial and continued stay reviews as designated in UM plan.
• Review records for medical necessity and collaborate with physicians and care team.
• Establish estimated LOS and communicate discharge planning with the team.
• Collaborate to enhance communication related to discharge planning and utilization management.
• Provide education to physicians and healthcare team to improve utilization management processes.

Skills

Basic computer skills

Electronic health record navigation

Written and verbal communication

Microsoft Office

Education

BSN degree

Tools

Microsoft Office

Job description

Duke Regional Hospital in Durham, North Carolina, is seeking a Utilization Manager / Medical Chart Auditor to ensure medical necessity and accurate patient status determinations across ED and inpatient services. The role supports denials management, discharge planning, and cost-effective care in a collaborative clinical setting.

BSN and Case Management Certification within 2 years are required, with a minimum of three years of acute clinical experience.