Clinical Utilization Review Specialist

Henderson Hospital; Raleigh (NC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Tuition Reimbursement

401(k) with company match

Career development opportunities

Job summary

Universal Health Services, Inc. seeks a Utilization Management professional to coordinate and monitor patient care across inpatient and outpatient programs. You will work to ensure appropriate utilization and timely authorizations with payors, while collaborating with the treatment team to optimize patient outcomes.

The role requires clinical assessment knowledge, documentation discipline, and strong communication skills to support admission decisions and discharge planning in a hospital setting.

Qualifications

• Bachelor degree in Nursing, Counseling, Psychology or Social Work; Masters degree preferred.
• RN Licensure or Master’s degree in Behavioral Health.
• Experience in Utilization Management in a hospital setting is preferred.

Responsibilities

• Coordinate and monitor utilization and documentation for inpatients and outpatients.
• Coordinate authorization with third‑party payors.
• Review admissions, continued stays, and discharge planning for appropriateness.
• Attend daily treatment team meetings to discuss acuity and payor needs.
• Submit appeals to third‑party payors with supporting data.
• Communicate insurance information to team members and update records.

Skills

DSM methodology

Telephone etiquette

Interpersonal skills

Written communication

Time management

Crisis management

Medical terminology

Education

Bachelor degree in Nursing, Counseling, Psychology or Social Work

RN Licensure or Master’s degree in Behavioral Health

Masters degree preferred

Job description

Universal Health Services, Inc. seeks a Utilization Management professional to coordinate and monitor patient care across inpatient and outpatient programs. You will work to ensure appropriate utilization and timely authorizations with payors, while collaborating with the treatment team to optimize patient outcomes.

The role requires clinical assessment knowledge, documentation discipline, and strong communication skills to support admission decisions and discharge planning in a hospital setting.