RN Utilization Review Specialist - Optimize Admissions

UofL Health; Louisville (KY); On-site; USD 65,000 - 95,000; Full time

Job summary

UofL Health in Louisville seeks an Utilization Review RN to support the Utilization Management process, assessing medical necessity for admission and continued stay, coordinating care with physicians and case managers, and ensuring compliance with CMS, payor guidelines, and regulatory requirements.

Requirements include ADN or Associate's degree in nursing, RN license in Kentucky, 2 years of RN experience (3 years with Behavioral Health for Peace Hospital); BSN preferred.

Qualifications

• ADN or Associate’s degree in nursing required; BSN preferred.
• Current Kentucky RN license; able to work in Kentucky.
• Minimum 2 years RN experience; 3 years in behavioral health for Peace Hospital.

Responsibilities

• Conduct admission and concurrent utilization reviews to determine medical necessity.
• Communicate with physicians and payors to secure authorization and document approvals.
• Educate staff on payers, documentation, and compliance issues.
• Maintain compliance with CMS, JCAHO, and payer requirements.

Skills

Utilization review

Interdisciplinary collaboration

Clinical judgment

Communication skills

Education

Associate's degree in Nursing (ADN)

BSN preferred

Job description

UofL Health in Louisville seeks an Utilization Review RN to support the Utilization Management process, assessing medical necessity for admission and continued stay, coordinating care with physicians and case managers, and ensuring compliance with CMS, payor guidelines, and regulatory requirements.

Requirements include ADN or Associate's degree in nursing, RN license in Kentucky, 2 years of RN experience (3 years with Behavioral Health for Peace Hospital); BSN preferred.