RN Utilization Review: Drive Patient-Centered Care

University Medical Center, Inc.; United States; On-site; USD 80,000 - 110,000; Full time

Job summary

UofL Health is seeking an experienced Utilization Review RN to support the Utilization Management function. The role requires evaluating medical necessity for admission and continued stay, screening against payer guidelines, and communicating with physicians and payors to secure approvals.

Strong nursing knowledge, organizational skills, and attention to regulatory requirements are essential. The position involves admission and concurrent reviews across services, maintaining documentation in

Qualifications

• RN with active Kentucky license or compact license
• Two years RN experience required; case management/utilization management preferred
• Experience in behavioral health is preferred for certain locations

Responsibilities

• Conduct admission and concurrent utilization reviews using current criteria
• Communicate with physicians and payors regarding approvals/denials
• Document clinical information and maintain confidentiality
• Educate providers and staff on payor guidelines and regulatory requirements
• Assist with coordination of care to ensure appropriate level of care

Skills

Clinical reasoning

Communication

Critical thinking

Attention to detail

Education

ADN

BSN preferred

RN with business/health admin background

Tools

Case Management Software

MS Office (Word, Excel, Outlook)

Job description

UofL Health is seeking an experienced Utilization Review RN to support the Utilization Management function. The role requires evaluating medical necessity for admission and continued stay, screening against payer guidelines, and communicating with physicians and payors to secure approvals.

Strong nursing knowledge, organizational skills, and attention to regulatory requirements are essential. The position involves admission and concurrent reviews across services, maintaining documentation in