Nurse Utilization Review Specialist III

BBSS Beyond Blue; United States; On-site; USD 30,000 - 48,000; Part time

Job summary

UK King’s Daughters is seeking a part-time discharge planning specialist to evaluate admissions, ensure documentation accuracy, and designate the appropriate level of care. You will work across the care team to maintain high-quality patient care and smooth transitions.

You will liaise with physicians, nursing staff, social workers, patients, and payers to ensure medical necessity, timely authorizations, and coordinated post-acute services including home health and DME.

Qualifications

• ADN or equivalent nursing credential required.
• 3-5 years of related experience in hospital discharge or care coordination.
• Experience with payer requirements (Medicare/Medicaid) preferred.

Responsibilities

• Assess newly admitted patients for hospitalization suitability and level of care.
• Coordinate with physicians, nursing staff, and social workers on medical necessity and documentation.
• Work with insurance providers to obtain authorizations for continued hospitalization.
• Coordinate home health services and DME post-discharge.
• Support care transitions and effective communication within the care team.
• Perform other duties as assigned.

Skills

Nursing liaison

Documentation

Medical record review

Interdisciplinary communication

Education

ADN

Job description

At UK King's Daughters, we’re not just a healthcare facility — we’re a family of dedicated professionals who share a passion for making a meaningful difference in the lives of our patients. We’re more than just a place to work; we’re a place to grow, thrive, and contribute to our community.

Job Summary

Responsible for evaluating all newly admitted patients to ensure appropriate hospitalization, documentation accuracy, order entry, and proper designation of level of care. Serves as a key liaison between physicians, nursing staff and weekend social workers, patients, insurance providers, and government payers to ensure quality patient care and proper reimbursement. Collaborates on discharge planning and coordinate post-acute services such as home health and durable medical equipment

Essential Functions

• Assesses all newly admitted patients for appropriate hospitalization, accurate documentation, proper order entry, and correct level of care designation.
• Conducts daily reviews for patients whose payer requires continued review, ensuring medical necessity is consistently documented and communicated.
• Collaborates with physicians regarding patient status, level of care, and necessary documentation to meet medical necessity and payer requirements.
• Serves as a liaison with insurance companies, Medicare, and Medicaid to provide timely updates, submit required medical information, and secure authorizations for continued hospitalization.
• Works closely with nursing staff and weekend social workers to assess patient needs and coordinate home health services, durable medical equipment (DME), and other post-discharge resources.
• Partners with the healthcare team to facilitate effective communication, ensure continuity of care, and support safe and efficient patient transitions.
• Performs other duties as assigned.

Education Requirement

Associate Degree - ADN

Experience Requirement

3-5 Years. An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.

Certifications & Licensures

Nursing License

Working Conditions

• A. Lifting, pushing, and/or pulling objects up to 50lbs: Never (<10% of the time)
• B. Lifting, pushing, and/or pulling objects over 50lbs: Never
• C. Standing or walking with objects up to 10lbs: Intermittent (10% - 50% of the time)
• D. Standing or walking with objects up to 25lbs: Never (<10% of the time)
• E. Sitting at the computer workstation for extended periods: Intermittent (100% of the time)
• F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials: Occasional (<10% of the time)
• G. Repetitive motion: Intermittent (100% of the time)
• H. Working at heights above 4 feet: Never
• I. Working in confined spaces: Never
• J. Risk of injuries from use of equipment on the job: Occasional (<10% of the time)
• K. Job‑related travel: Occasional (<10% of the time)
• L. Loud noises: Never
• M. Temperature extremes: Never
• N. Hazardous chemicals and fumes including waste: Never (<10% of the time)
• O. Radiation: Never
• P. Burns: Never
• Q. Cuts/Punctures: Never (<10% of the time)
• R. Bloodborne/airborne pathogens: Occasional (<10% of the time)
• S. Recombinant DNA or viral vectors: Never
• T. Combative/violent people: Never
• U. Animal handling (including carcasses): Never
• V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

Physical Demands

This position requires sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); and intermittent standing or walking with objects weighing up to 10 pounds.

Department Information

Department: Review
Shift: Day (United States of America)
Time Type: Part time
Address: 800 Rose Street City, State: Lexington, Kentucky

Our growth is creating opportunities! Our team is expanding, and we want to hire the most talented people we can. Continued success depends on it!

Our Work Experience is the combination of everything that’s unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it’s our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful.