RN Utilization Review Specialist

UofL Health; Louisville (KY); On-site; USD 70,000 - 90,000; Full time

Job summary

UofL Health in Louisville, KY seeks an experienced Utilization Review RN to support the Utilization Management function. You will assess medical necessity for admissions and continued stay, coordinate with physicians and case managers, and document in Case Management Software to ensure appropriate care levels and financial accountability.

Responsibilities include concurrent reviews, payer communications, and education of staff and clinicians on payor guidelines and regulatory requirements.

Qualifications

• ADN or associate degree in nursing required.
• Active Kentucky RN license.
• Two years’ experience as an RN required.
• One year in case management/utilization management preferred.
• Three years’ experience with Behavioral Health preferred.

Responsibilities

• Promotes utilization review by certifying medical necessity.
• Communicates with physicians and case managers about approvals/denials.
• Documents information in Case Management Software.
• Educates physicians, patients, and staff on payors and compliance.
• Coordinates care with interdisciplinary team during reviews.
• Ensures timely admission and concurrent reviews for appropriate level of care.

Skills

Communication

Organization

Critical thinking

RN license

Education

ADN or Associate degree in nursing

BSN preferred

Tools

MS Word

Excel

Outlook

Job description

UofL Health in Louisville, KY seeks an experienced Utilization Review RN to support the Utilization Management function. You will assess medical necessity for admissions and continued stay, coordinate with physicians and case managers, and document in Case Management Software to ensure appropriate care levels and financial accountability.

Responsibilities include concurrent reviews, payer communications, and education of staff and clinicians on payor guidelines and regulatory requirements.