RN Utilization Review: Drive Care & Authorization

UofL Health, Inc.; Louisville, Northern (KY, KY); Hybrid; USD 70,000 - 95,000; Full time

Job summary

UofL Health seeks an Utilization Review RN to support the Utilization Management process, making clinical recommendations on medical necessity for admission and continued stay. You will screen patients against guidelines, coordinate with physicians and case managers, and document in Case Management Software.

The role requires a nursing degree (ADN or BSN preferred), 2+ years as an RN, and familiarity with payer requirements; experience in case management is a plus.

Qualifications

• ADN or BSN required or preferred with consideration for equivalent experience.
• Minimum 2 years RN experience; case management/utilization management experience preferred.
• Active Kentucky RN license or compact license.
• Case management certification preferred; knowledge of payer requirements.

Responsibilities

• Promotes optimal management of clinical resources via admission and concurrent UM reviews.
• Certifies medical necessity for admission, continued stay and discharge reviews.
• Documents clinical information in Case Management Software and communicates with physicians.
• Coordinates care with interdisciplinary team to ensure appropriate level of care and payer approvals.

Skills

Attention to detail

Organizational skills

Communication skills

Problem solving

Education

Associate degree in nursing (ADN)

Bachelor of Science in Nursing (BSN) preferred

Tools

Microsoft Word

Excel

Outlook

Electronic Medical Records

Job description

UofL Health seeks an Utilization Review RN to support the Utilization Management process, making clinical recommendations on medical necessity for admission and continued stay. You will screen patients against guidelines, coordinate with physicians and case managers, and document in Case Management Software.

The role requires a nursing degree (ADN or BSN preferred), 2+ years as an RN, and familiarity with payer requirements; experience in case management is a plus.