Utilization Manager: Care Coordination & Denials

Duke Clinical Research Institute; Mooresville (NC); On-site; USD 70,000 - 100,000; Full time

Job summary

Duke Health Lake Norman Hospital in Mooresville, NC seeks a Utilization Manager/Medical Chart Auditor to verify medical necessity and manage denials. You will work with physicians and care teams to optimize patient flow and discharge planning, ensuring accurate chart reviews and adherence to UM plans.

Required BSN, NC RN licensure, and at least three years of acute care experience, plus CM certification within 2 years.

Qualifications

• BSN required and current NC RN licensure is essential.
• Minimum of three years of recent acute clinical practice or related health care experience.
• Case Management Certification (ACM, CCM or ANCC) within 2 years of hire.

Responsibilities

• Assesses accuracy of patient class to reflect clinical condition and utilization review outcomes.
• Supports chart audit processes ensuring medical necessity and level of care documentation.
• Collaborates with care team to address discharge planning and utilization management.
• Delivers education to physicians and the healthcare team to improve processes and outcomes.
• Maintains communication with internal and external stakeholders to safeguard results.

Skills

Computer proficiency

EHR navigation

Self-directed work

Written and verbal communication

MS Word/PowerPoint/Excel

Education

BSN degree

RN licensure in NC

Tools

Microsoft Word

PowerPoint

Excel

Job description

Duke Health Lake Norman Hospital in Mooresville, NC seeks a Utilization Manager/Medical Chart Auditor to verify medical necessity and manage denials. You will work with physicians and care teams to optimize patient flow and discharge planning, ensuring accurate chart reviews and adherence to UM plans.

Required BSN, NC RN licensure, and at least three years of acute care experience, plus CM certification within 2 years.