Behavioral Health Utilization Manager — Drive Care

Duke Clinical Research Institute; Durham (NC); On-site; USD 75,000 - 105,000; Full time

Benefits offered by this job

Relocation assistance (eligibility)

Job summary

Duke Regional Hospital in Durham, North Carolina, seeks a dedicated Utilization Manager / Medical Chart Auditor to optimize patient care through review of medical necessity, discharge planning, and payer denials.

You will collaborate with physicians, case managers, and the care team to ensure timely authorizations, accurate documentation, and compliant utilization management under the UM plan. Requires BSN, NC RN license, and CM certification within 2 years.

Qualifications

• BSN required
• Current RN licensure in NC
• Case Management Certification (ACM, CCM or ANCC) within 2 years of hire
• Minimum three years of acute clinical practice or related health care experience

Responsibilities

• Validate bedded patients and payer authorization within contractual timeframes.
• Manage concurrent cases to resolution of care affecting payer approval.
• Conduct initial review and continued stay reviews per UM plan.
• Review records for medical necessity with care team.
• Communicate estimated LOS and discharge date using GMLOS.
• Support denials management and appeals as needed.
• Collaborate with care team to enhance discharge planning and utilization management.
• Provide education to physicians and staff on UM processes and compliance.

Skills

Basic computer skills

EHR navigation

Communication skills

MS Word

PowerPoint

Excel

Education

BSN

RN licensure in NC

Job description

Duke Regional Hospital in Durham, North Carolina, seeks a dedicated Utilization Manager / Medical Chart Auditor to optimize patient care through review of medical necessity, discharge planning, and payer denials.

You will collaborate with physicians, case managers, and the care team to ensure timely authorizations, accurate documentation, and compliant utilization management under the UM plan. Requires BSN, NC RN license, and CM certification within 2 years.