RN Utilization Review Specialist

UofL Health, Inc.; Louisville (KY); On-site; USD 75,000 - 100,000; Full time

Job summary

UofL Health is seeking a Utilization Review RN to support utilization management activities, including admission and concurrent reviews, payor communications, and care coordination. The role requires RN licensure in Kentucky and experience in case management or utilization management.

The position emphasizes collaboration with physicians and care teams to ensure medical necessity and appropriate resource use across designated services.

Qualifications

• ADN or BSN required with RN licensure in Kentucky
• Two years’ RN experience; utilization/case management experience preferred
• Knowledge of Medicare/Medicaid guidelines and MCG criteria

Responsibilities

• Perform admission and concurrent reviews to determine medical necessity
• Communicate with physicians and payors regarding approvals/denials
• Document authorization numbers and length of stay in the Case Management Software
• Ensure appropriate level of care and resource utilization
• Educate staff and physicians on payor requirements and regulatory guidelines

Skills

Utilization Review

RN

Case Management

Medicare/Medicaid

MCG Guidelines

Communication

Education

ADN or BSN

Tools

Case Management Software

Job description

UofL Health is seeking a Utilization Review RN to support utilization management activities, including admission and concurrent reviews, payor communications, and care coordination. The role requires RN licensure in Kentucky and experience in case management or utilization management.

The position emphasizes collaboration with physicians and care teams to ensure medical necessity and appropriate resource use across designated services.