Utilization Manager - Care Denials & Discharge Champion

Duke Careers; Raleigh (NC); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Relocation assistance

Job summary

Duke Raleigh Hospital, a campus of Duke University Health System, is seeking an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity and proper discharge planning. The role collaborates with physicians, case management, and care teams to optimize patient flow and resource use in a high-acuity setting.

BSN required with at least three years of acute clinical practice; CCM/ACM certification within 2 years is preferred. Strong communication and EHR skills are essential.

Qualifications

• BSN required.
• Minimum of three years recent acute clinical practice or related health care experience.

Responsibilities

• Validate bedded patients and payer authorization within contractual timeframes.
• Conduct initial and continued stay reviews per UM plan.
• Assess medical necessity and collaborate with physicians and care team to validate information.
• Communicate estimated LOS and discharge planning with care team.
• Provide education to physicians and healthcare team on utilization management.

Skills

Basic computer proficiency

Microsoft Word/PowerPoint/Excel

Education

BSN

Tools

Microsoft Word

Excel

PowerPoint

Job description

Duke Raleigh Hospital, a campus of Duke University Health System, is seeking an experienced Utilization Manager/Medical Chart Auditor to ensure medical necessity and proper discharge planning. The role collaborates with physicians, case management, and care teams to optimize patient flow and resource use in a high-acuity setting.

BSN required with at least three years of acute clinical practice; CCM/ACM certification within 2 years is preferred. Strong communication and EHR skills are essential.