RN Utilization Review Specialist - Care & Approvals

UofL Health; Louisville (KY); On-site; USD 75,000 - 95,000; Full time

Job summary

UofL Health is seeking a Utilization Review RN to perform admission and concurrent reviews, ensuring medical necessity and appropriate level of care across designated services. You will collaborate with physicians, case managers, and payors to secure authorizations while adhering to UM criteria and regulatory standards.

Requirements include an active Kentucky RN license with at least two years of nursing experience and experience in case management/utilization management; BSN preferred, with

Qualifications

• ADN or BSN required or in progress; BSN preferred.
• Two years RN experience required.
• Experience in case management/utilization management preferred.
• Behavioral health experience a plus for Peace Hospital positions.

Responsibilities

• Promote optimal resource management by conducting admission and concurrent UM reviews; document clinical data.
• Coordinate care with interdisciplinary team to ensure appropriate level of care.
• Communicate with payors and physicians to obtain and document authorization and discharge plans.
• Educate staff and physicians on payor guidelines, documentation, and regulatory requirements.
• Ensure compliance with HIPAA and organizational policies.

Skills

RN

Case Management

Utilization Review

Communication

Critical Thinking

Education

ADN

BSN

Tools

Case Management Software

Job description

UofL Health is seeking a Utilization Review RN to perform admission and concurrent reviews, ensuring medical necessity and appropriate level of care across designated services. You will collaborate with physicians, case managers, and payors to secure authorizations while adhering to UM criteria and regulatory standards.

Requirements include an active Kentucky RN license with at least two years of nursing experience and experience in case management/utilization management; BSN preferred, with