RN Utilization Review: Care Coordination & Approvals

University Medical Center, Inc.; Louisville (KY); On-site; USD 70,000 - 90,000; Full time

Job summary

UofL Health is seeking a Utilization Review RN for the Frazier Rehab Institute – UMC in Louisville, KY. The role focuses on medical necessity reviews, concurrent admissions, and coordinating with payors to secure authorizations.

The position requires an RN license in Kentucky, 2+ years of RN experience, and knowledge of UM criteria (MCG). Collaboration with physicians and care teams is essential to optimize patient care and ensure regulatory compliance.

Qualifications

• ADN or BSN preferred; RN must enroll in BSN within 1 year and complete within 3 years.
• Two years’ RN experience required; case management/UM experience preferred.
• Active Kentucky RN license or compact license to work in Kentucky.

Responsibilities

• Promotes optimal management of clinical resources by conducting admission and concurrent UM reviews.
• Evaluate medical records to identify delays affecting timely patient care.
• Maintain processes for determining admission status per payer requirements.
• Communicate with third party payors to secure authorizations.
• Educate physicians, patients, and staff on payors and compliance issues.
• Refer complex cases to care coordination leadership when needed.
• Support compliance with HIPAA and CMS regulations.
• Document information in Case Management Software.

Skills

Utilization Review

RN licensed

Case management

Regulatory knowledge

Education

ADN

Bachelor of Science in Nursing

Tools

Case Management Software

MCG Care Guidelines

Job description

UofL Health is seeking a Utilization Review RN for the Frazier Rehab Institute – UMC in Louisville, KY. The role focuses on medical necessity reviews, concurrent admissions, and coordinating with payors to secure authorizations.

The position requires an RN license in Kentucky, 2+ years of RN experience, and knowledge of UM criteria (MCG). Collaboration with physicians and care teams is essential to optimize patient care and ensure regulatory compliance.