RN Utilization Review Specialist

UofL Health; Louisville (KY); Presencial; USD 70.000 - 100.000; Jornada completa

Descripción de la vacante

UofL Health is seeking a Utilization Review RN at the Frazier Rehab Institute - UMC in Louisville, KY. The role focuses on conducting utilization management activities, ensuring medical necessity for admission and continued stay, and coordinating with physicians and payors to optimize patient care and financial accountability.

The ideal candidate has RN licensure with ADN/BSN pathways and at least two years of RN experience, with familiarity of UM criteria and payer guidelines.

Formación

• ADN or BSN required/preferred for RN licensure.
• Two years of RN experience required.
• Familiarity with UM criteria and payor guidelines.
• Knowledge of Medicare/Medicaid guidelines helpful.

Responsabilidades

• Certify medical necessity for admission and continued stay.
• Conduct concurrent reviews and update case management software.
• Coordinate with physicians and payors for authorization.
• Identify delays or barriers to timely patient care.
• Educate staff and physicians on payor requirements and documentation.
• Communicate important utilization decisions to care teams.
• Assist with regulatory compliance and OIG-related activities.
• Refer complex cases to leadership when needed.

Conocimientos

Utilization Review

RN

Case Management

Healthcare Administration

Educación

ADN

BSN

Descripción del empleo

UofL Health is seeking a Utilization Review RN at the Frazier Rehab Institute - UMC in Louisville, KY. The role focuses on conducting utilization management activities, ensuring medical necessity for admission and continued stay, and coordinating with physicians and payors to optimize patient care and financial accountability.

The ideal candidate has RN licensure with ADN/BSN pathways and at least two years of RN experience, with familiarity of UM criteria and payer guidelines.