RN: Utilization Management & Care Coordination

UofL Health; Louisville (KY); On-site; USD 70,000 - 95,000; Full time

Job summary

UofL Health seeks a qualified Utilization Review RN to support the Utilization Management program. The role involves performing admission and concurrent reviews, ensuring medical necessity, and coordinating with physicians, case managers, and payors to secure authorizations.

The ideal candidate has an RN license with ADN or BSN, at least two years of RN experience, and familiarity with UM processes and regulatory guidelines. Strong communication and organizational skills are essential.

Qualifications

• RN with ADN or BSN preferred.
• Two years of RN experience required.
• Case management/utilization management experience preferred.

Responsibilities

• Conduct admission and concurrent utilization reviews using current criteria.
• Communicate with payors for authorization and document outcomes.
• Educate physicians and staff on payor requirements and documentation.
• Maintain and utilize Case Management Software for nursing decisions.

Skills

Attention to detail

Organizational skills

Interpersonal skills

Communication skills

Problem solving

Education

ADN

BSN preferred

Tools

Microsoft Word

Microsoft Excel

Outlook

Electronic medical records

Job description

UofL Health seeks a qualified Utilization Review RN to support the Utilization Management program. The role involves performing admission and concurrent reviews, ensuring medical necessity, and coordinating with physicians, case managers, and payors to secure authorizations.

The ideal candidate has an RN license with ADN or BSN, at least two years of RN experience, and familiarity with UM processes and regulatory guidelines. Strong communication and organizational skills are essential.