Behavioral Health Utilization Manager (RN)

Duke Health; Durham (NC); On-site; USD 85,000 - 105,000; Full time

Job summary

Duke Regional Hospital in Durham, NC, is seeking a Utilization Manager/Medical Chart Auditor to join Duke Health. You will validate bedded patient and payer authorizations and perform UM reviews to ensure medical necessity and proper discharge planning.

Required: BSN, active NC RN license, Case Management Certification within 2 years, and at least three years of acute care experience. Excellent documentation and communication skills are essential for cross-team collaboration.

Qualifications

• BSN required and current RN licensure in NC
• Case Management Certification (ACM, CCM or ANCC) within 2 years of hire
• Minimum of three years recent acute clinical practice or related health care experience
• Case management knowledge and utilization management familiarity preferred

Responsibilities

• Validate bedded patient and commercial payer authorizations within contractual timeframes.
• Manage concurrent cases to resolution of care impacting payer approval as medically necessary.
• Perform initial and continued stay reviews per UM plan and document medical necessity.
• Collaborate with physicians and care team to ensure accurate documentation and discharge planning.
• Educate physicians and staff on utilization management processes and compliance.

Skills

Basic computer proficiency

EHR navigation

Self-directed work style

Problem solving

Verbal & written communication

MS Word / PowerPoint / Excel

Education

Bachelor of Science in Nursing (BSN)

Tools

EHR systems

Microsoft Word

PowerPoint

Excel

Job description

Duke Regional Hospital in Durham, NC, is seeking a Utilization Manager/Medical Chart Auditor to join Duke Health. You will validate bedded patient and payer authorizations and perform UM reviews to ensure medical necessity and proper discharge planning.

Required: BSN, active NC RN license, Case Management Certification within 2 years, and at least three years of acute care experience. Excellent documentation and communication skills are essential for cross-team collaboration.