RN Utilization Review & Care Coordination Specialist

Lexington Health, Inc.; West Columbia (SC); On-site; USD 60,000 - 85,000; Full time

Benefits offered by this job

Day ONE medical, dental and life ins.

403(b) plan match

Short/Long-term disability

Adoption assistance

Student loan forgiveness

Job summary

Lexington Health is seeking a Registered Nurse to perform admission and concurrent stay medical record reviews and collaborate with physicians and care teams in a hospital setting.

The role involves communicating with payors for authorization, supporting appropriate throughput, and ensuring documentation supports medical necessity and accurate level of care. Strong adherence to regulatory guidelines is essential.

Qualifications

• ADN, Diploma Nursing Degree, or BSN required.
• Minimum 3 years of experience in an acute care hospital setting.
• Registered Nurse licensed in the State of South Carolina.

Responsibilities

• Performs admission and concurrent stay medical record review to determine appropriateness of admission, continued stay, and setting.
• Communicates with attending physician and other health care providers.
• Reviews with third party payors to obtain authorization and supports appropriate level of care.
• Documents and uses InterQual criteria for admission decisions.
• Assists in denial management and ensures regulatory compliance and revenue integrity.

Skills

Communication skills

Teamwork

Patient care

Attention to detail

Education

ADN

Diploma Nursing Degree

BSN

Job description

Lexington Health is seeking a Registered Nurse to perform admission and concurrent stay medical record reviews and collaborate with physicians and care teams in a hospital setting.

The role involves communicating with payors for authorization, supporting appropriate throughput, and ensuring documentation supports medical necessity and accurate level of care. Strong adherence to regulatory guidelines is essential.