Utilization Manager & Medical Necessity Specialist

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

Benefits offered by this job

Relocation Assistance

Job summary

Duke Regional Hospital in Durham, NC seeks an experienced Utilization Manager/Medical Chart Auditor to support utilization review and clinical documentation.

You will validate bedded patient authorizations, collaborate with physicians, and assist with discharge planning to optimize patient flow and care efficiency. A BSN and NC RN license are required, with CM certification within 2 years and BLS.

Qualifications

• Basic computer proficiency required.
• Ability to become proficient in the navigation and interpretation of an electronic health record.
• Work effectively in a self-directed role, multi-task, capable of daily problem-solving complex issues.
• Excellent written and verbal skills.
• Basic proficiency in the use of Microsoft Word, Power Point and Excel.

Responsibilities

• Validate authorization for bedded patients and payer approvals within contractual timeframes.
• Manage concurrent cases to resolution of care, potentially impacting payer approval.
• Conduct retrospective medical necessity reviews per UM plan and guidelines.
• Collaborate with physicians and care team to ensure accurate discharge planning and utilization management.
• Provide education to physicians and staff to improve UM processes and outcomes.

Skills

Computer skills

EHR navigation

Multitasking

Communication skills

MS Office

Education

BSN required

Job description

Duke Regional Hospital in Durham, NC seeks an experienced Utilization Manager/Medical Chart Auditor to support utilization review and clinical documentation.

You will validate bedded patient authorizations, collaborate with physicians, and assist with discharge planning to optimize patient flow and care efficiency. A BSN and NC RN license are required, with CM certification within 2 years and BLS.