RN Utilization Manager- Optimize Patient Care & Transitions

UNC Health Care; Smithfield (NC); On-site; USD 50,000 - 72,000; Full time

Job summary

UNC Health Care in North Carolina seeks a Utilization Manager (RN) to collaborate with the patient/family and inter-disciplinary teams from admission through discharge. You will assess care progression, coordinate with physicians and payors, and ensure appropriate utilization and documentation.

The role emphasizes revenue protection, accurate coding support, and alignment with the Hospital's Utilization Management Plan. Requires NC RN licensure and prior utilization experience.

Qualifications

• Graduation from a state-accredited school of professional nursing.
• Licensed to practice as a Registered Nurse in the state of North Carolina.
• Two (2) years of clinical experience in a medical facility or Utilization Management.

Responsibilities

• Perform admission, continued stay, and discharge reviews using approved criteria.
• Collaborate with physicians, nursing, and care providers to ensure timely documentation and appropriate level of care.
• Coordinate with payors and internal teams to obtain pre-certifications and re-certifications as required.
• Support data entry and reporting to monitor utilization and care outcomes.

Skills

RN licensure

Clinical review

Utilization management

Discharge planning

Education

RN licensure in NC

Tools

EMR systems

Job description

UNC Health Care in North Carolina seeks a Utilization Manager (RN) to collaborate with the patient/family and inter-disciplinary teams from admission through discharge. You will assess care progression, coordinate with physicians and payors, and ensure appropriate utilization and documentation.

The role emphasizes revenue protection, accurate coding support, and alignment with the Hospital's Utilization Management Plan. Requires NC RN licensure and prior utilization experience.