Healthcare Utilization & Denials Lead

Duke Health; Mooresville (NC); On-site; USD 70,000 - 100,000; Full time

Benefits offered by this job

Relocation assistance

Job summary

Duke Health Lake Norman Hospital is seeking a Utilization Manager/Medical Chart Auditor to ensure accurate medical necessity determinations, coordinate discharge planning, and support payer denials management. The role emphasizes collaboration with physicians and care teams to optimize resource use and patient flow.

Position requires BSN, NC RN licensure, BLS, and 3+ years of acute care experience, with CCM/ACM within 2 years of hire.

Qualifications

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

Responsibilities

• Validate authorization for bedded patients and timely payer approvals.
• Manage concurrent cases and determine medical necessity for discharge.
• Conduct initial and continued stay reviews per UM plan.
• Review medical records to verify necessity and collaborate with physicians and care teams.
• Communicate estimated LOS and discharge plans with the care team.
• Educate physicians and teams to improve utilization management processes.

Skills

Basic computer proficiency

EHR navigation

Multitasking

Written and verbal communication

MS Word/PowerPoint/Excel

Education

BSN

Job description

Duke Health Lake Norman Hospital is seeking a Utilization Manager/Medical Chart Auditor to ensure accurate medical necessity determinations, coordinate discharge planning, and support payer denials management. The role emphasizes collaboration with physicians and care teams to optimize resource use and patient flow.

Position requires BSN, NC RN licensure, BLS, and 3+ years of acute care experience, with CCM/ACM within 2 years of hire.