Clinical Utilization Manager

Duke University Health System; Durham (NC); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Relocation assistance

Job summary

Duke University Health System in Durham, NC seeks an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity, accuracy of patient status, and compliant utilization review across care transitions. The role partners with physicians, case managers, and payors to optimize patient flow and financial stewardship.

The candidate should hold a BSN, have at least three years of acute care experience, and obtain a Case Management Certification within two years.

Qualifications

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

Responsibilities

• Validates bedded patients and payer authorizations within contractual timelines.
• Manages concurrent cases to resolution of care and potential payer approval.
• Performs initial and continued stay reviews per UM plan.
• Reviews medical necessity and collaborates with physicians and care team.
• Communicates estimated LOS and discharge dates using GMLOS.
• Supports denials management and appeals per UM plan.
• Collaborates with care team to optimize discharge planning and utilization management.
• Maintains education for physicians and healthcare team to improve processes and outcomes.

Skills

Communication skills

Analytical thinking

Problem solving

Education

BSN

Tools

Electronic Health Record

Microsoft Word

PowerPoint

Excel

Job description

Duke University Health System in Durham, NC seeks an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity, accuracy of patient status, and compliant utilization review across care transitions. The role partners with physicians, case managers, and payors to optimize patient flow and financial stewardship.

The candidate should hold a BSN, have at least three years of acute care experience, and obtain a Case Management Certification within two years.