Clinical Utilization Leader

Duke Careers; Durham (NC); On-site; USD 90,000 - 110,000; Full time

Job summary

Duke Regional Hospital in Durham, NC seeks a full-time Utilization Manager/Medical Chart Auditor to oversee patient class status accuracy, support denials management, and coordinate with care teams for efficient discharge planning.

The role requires a BSN, NC RN licensure, and active case management certification within 3 years, with at least three years of acute clinical experience. Collaboration with physicians and care teams is essential to optimize resource use.

Qualifications

• BSN required and RN licensure in NC.
• Case management certification within 3 years of hire.
• Minimum of three years of acute clinical practice or related health care experience.

Responsibilities

• Validate patient status and hospital utilization, ensure accuracy of medical chart documentation.
• Lead denials management and peer-to-peer conversations to support appropriate utilization.
• Collaborate with physicians, care team, and CM/CSW for discharge planning and care transitions.
• Educate physicians and healthcare team on utilization review processes and compliance.

Skills

EHR navigation

Multi-tasking

Verbal communication

MS Word/Excel basics

Education

BSN

RN licensure in NC

Case Management Certification (ACM/CCM/ANCC) within 3 years

Job description

Duke Regional Hospital in Durham, NC seeks a full-time Utilization Manager/Medical Chart Auditor to oversee patient class status accuracy, support denials management, and coordinate with care teams for efficient discharge planning.

The role requires a BSN, NC RN licensure, and active case management certification within 3 years, with at least three years of acute clinical experience. Collaboration with physicians and care teams is essential to optimize resource use.