Utilization Manager & Medical Chart Auditor

Duke Clinical Research Institute; Durham (NC); On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Relocation assistance

Job summary

Duke Regional Hospital in Durham, NC, seeks a Utilization Manager/Medical Chart Auditor to ensure accurate patient class assignments and timely documentation for utilization review. You will validate bedded patients, coordinate with payers, and support discharge planning with the care team.

Required BSN and NC RN licensure; CCM/ACM certification within 3 years is preferred. Collaboration with physicians and case management is essential to optimize care and resource use.

Qualifications

• BSN required.
• Current RN licensure in NC or compact state.
• Case Management Certification (ACM/CCM/ANCC) within 3 years.

Responsibilities

• Assesses patient class/status to reflect clinical condition and utilization review outcomes.
• Validates bedded patient authorization and payer eligibility.
• Collaborates with care team to ensure discharge planning aligns with UM plan.

Skills

Computer proficiency

EHR navigation

Multi-tasking

Written & verbal communication

MS Word/PowerPoint/Excel

Education

BSN

Case Management Certification within 3 years

Tools

Electronic Health Record (EHR)

Job description

Duke Regional Hospital in Durham, NC, seeks a Utilization Manager/Medical Chart Auditor to ensure accurate patient class assignments and timely documentation for utilization review. You will validate bedded patients, coordinate with payers, and support discharge planning with the care team.

Required BSN and NC RN licensure; CCM/ACM certification within 3 years is preferred. Collaboration with physicians and case management is essential to optimize care and resource use.