Utilization & Care Coordination Manager

Duke University Health System; Durham (NC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Relocation assistance

Job summary

Duke Regional Hospital, part of Duke University Health System, seeks a Utilization Manager/Medical Chart Auditor to ensure medical necessity, manage bed utilization, and collaborate with physicians and care teams. The role emphasizes timely reviews, discharge planning, and payor communication within UM guidelines.

Requires BSN and NC RN licensure, with at least three years of acute clinical experience and case management certification within two years of hire.

Qualifications

• BSN and NC RN licensure required.
• Three years of acute clinical practice or related health care experience.
• Case management certification within 2 years of hire.

Responsibilities

• Validate bedded patient and payer authorizations within contractual timeframe.
• Manage concurrent cases toward resolution of care and payer approval.
• Conduct initial and continued stay reviews under UM plan.
• Review records for medical necessity with physician and care team.
• Estimate LOS and discharge date using GMLOS.
• Apply evidence-based criteria to support medical necessity; refer complex cases.
• Collaborate with care team to improve discharge planning and utilization management.
• Provide education to physicians and healthcare team on UM and compliance.
• Participate in hospital committee and quality improvement activities.

Skills

Computer proficiency

EHR navigation

Self-directed

Multitasking

Written and verbal skills

MS Office

Education

BSN required

RN licensure in NC

Case management certification within 2 years

Tools

Microsoft Word

PowerPoint

Excel

Job description

Duke Regional Hospital, part of Duke University Health System, seeks a Utilization Manager/Medical Chart Auditor to ensure medical necessity, manage bed utilization, and collaborate with physicians and care teams. The role emphasizes timely reviews, discharge planning, and payor communication within UM guidelines.

Requires BSN and NC RN licensure, with at least three years of acute clinical experience and case management certification within two years of hire.