RN Utilization Review Specialist

UofL Health; Louisville (KY); In loco; USD 85.000 - 105.000; Tempo pieno

Descrizione del lavoro

UofL Health in Louisville, KY is seeking a Utilization Review RN to support utilization management across inpatient and observation services. You will assess medical necessity, coordinate with physicians and case managers, and ensure payor approvals and appropriate discharge planning.

Required RN license in Kentucky with 2 years of RN experience; BSN preferred or pursued within three years. Strong communication and teamwork are essential in this role within a large academic health system.

Competenze

• RN with active Kentucky license or compact license.
• Two years' RN experience; case management/utilization management preferred.
• BSN pursuit within three years of employment.

Mansioni

• Promotes optimal management of clinical resources by conducting admission and concurrent utilization review.
• Evaluates medical records during concurrent review to ensure timely care and resource use.
• Maintains processes for determining appropriate admission status per payer requirements.
• Communicates with payors to obtain authorization and documents approval details.
• Educates physicians, patients, and staff on payors, documentation, and compliance issues.
• Collaborates with care team to optimize utilization and reduce barriers to care.

Conoscenze

Utilization Review

Case Management

Nursing (RN)

Communication

Team Collaboration

Formazione

Associate's degree in nursing (Required)

Bachelor of Science in Nursing (preferred)

BSN within 3 years of employment (required condition)

Strumenti

Case Management Software

Electronic Medical Records (EMR)

Descrizione del lavoro

UofL Health in Louisville, KY is seeking a Utilization Review RN to support utilization management across inpatient and observation services. You will assess medical necessity, coordinate with physicians and case managers, and ensure payor approvals and appropriate discharge planning.

Required RN license in Kentucky with 2 years of RN experience; BSN preferred or pursued within three years. Strong communication and teamwork are essential in this role within a large academic health system.