RN Utilization Review Specialist

University Medical Center; Louisville (KY); On-site; USD 65,000 - 85,000; Full time

Job summary

University Medical Center is seeking a Utilization Review RN to support UM Care Management and Utilization Management processes. The role involves evaluating medical necessity for admissions and continued stays, screening against payer guidelines, and coordinating with physicians and case managers to ensure appropriate level of care.

The RN will conduct admission and concurrent reviews, document findings, and assist with billing and compliance issues in a fast-paced hospital setting in

Responsibilities

• Promotes utilization review by verifying medical necessity for admission, continued stay and discharge.
• Review concurrent cases and identify process delays to ensure appropriate resource use.
• Communicate with payors to obtain authorizations and document authorization details in the Case Manager Software.
• Educate physicians, patients, and staff on payor policies, documentation and compliance issues.
• Resolve billing problems related to patient status, payor source, denials and appeals.

Job description

University Medical Center is seeking a Utilization Review RN to support UM Care Management and Utilization Management processes. The role involves evaluating medical necessity for admissions and continued stays, screening against payer guidelines, and coordinating with physicians and case managers to ensure appropriate level of care.

The RN will conduct admission and concurrent reviews, document findings, and assist with billing and compliance issues in a fast-paced hospital setting in