Healthcare Utilization Manager & Care Coordination

Duke University Health System; Raleigh (NC); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Relocation Assistance

Job summary

Duke Raleigh Hospital, a campus of Duke University Hospital, is seeking an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity and appropriate level of care across inpatient and observation encounters.

In this role you will validate bedded patient authorizations, conduct retrospective medical necessity reviews, collaborate with physicians and case managers, and provide education to care teams on utilization management while advancing performance improvement

Qualifications

• BSN required.
• Minimum of three years recent acute clinical practice or related health care experience.
• Case Management Certification within 2 years of hire; NC RN licensure and BLS required.

Responsibilities

• Validate bedded patient authorizations and payer initiatives.
• Conduct retrospective medical necessity reviews per UM plan.
• Collaborate with physicians, CM/CSW, and care team on discharge planning and utilization management.
• Provide education to physicians and healthcare team to improve processes and outcomes.
• Participate in hospital committees and quality/performance improvement activities.

Skills

Basic computer proficiency

EMR/EHR systems

Communication skills

MS Word/Excel basics

Education

BSN

RN license in NC

Case Management Certification within 2 years

Tools

EMR/EHR systems

Job description

Duke Raleigh Hospital, a campus of Duke University Hospital, is seeking an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity and appropriate level of care across inpatient and observation encounters.

In this role you will validate bedded patient authorizations, conduct retrospective medical necessity reviews, collaborate with physicians and case managers, and provide education to care teams on utilization management while advancing performance improvement