Utilization Review/Patient Care Coordinator (FT)

Ashe Memorial Hospital; Jefferson (NC); On-site; USD 70,000 - 95,000; Full time

Job summary

Ashe Memorial Hospital in West Jefferson, NC seeks a Registered Nurse – Utilization Review / Patient Care Coordinator to coordinate care, support appropriate utilization of services, and facilitate safe transitions across the continuum of care.

This full-time, first-shift role partners with physicians and care teams to manage Swing Bed and Transitional Care programs, conduct reviews for medical necessity, and ensure regulatory compliance while guiding discharge planning.

Qualifications

• Current, unrestricted North Carolina Registered Nurse (RN) license.
• BLS Certification.
• Previous Utilization Review experience required.
• Strong communication, organization, and care coordination skills.
• Ability to manage multiple priorities while maintaining accuracy and attention to detail.
• Demonstrated ability to collaborate effectively with physicians, clinical teams, patients, and external partners.

Responsibilities

• Coordinate and manage the Swing Bed/Transitional Care Program.
• Conduct utilization reviews to ensure appropriate levels of care and optimize length of stay.
• Review admissions for medical necessity and regulatory compliance.
• Coordinate internal and external referrals and establish strong provider relationships.
• Collaborate with physicians, case management, nursing, and interdisciplinary care teams.
• Support comprehensive discharge planning and safe, timely transitions of care.
• Complete pre-authorizations and follow up on denials and related payer requirements.
• Monitor and maintain compliance with applicable regulatory, accreditation, and organizational standards.
• Serve as a resource to clinical teams regarding utilization, care coordination, and regulatory requirements.

Skills

Communication

Organization

Care coordination

Education

Registered Nurse License (NC)

BLS Certification

Job description

Registered Nurse – Utilization Review / Patient Care Coordinator

Ashe Memorial Hospital | West Jefferson, NC
Full-Time | Monday–Friday | 1st Shift

Coordinate Care. Improve Outcomes. Make a Difference.

At Ashe Memorial Hospital, we are committed to our mission: “To meet the needs of the community by delivering patient-centered, high-quality health care.”

We are proud to be recognized as Ashe’s Best Place to Work for 2022, 2023, 2024, and 2025, reflecting our commitment to creating a supportive, collaborative environment where our team members can thrive.

We are seeking an experienced Registered Nurse – Utilization Review / Patient Care Coordinator to join our team. This position plays a vital role in coordinating patient care, supporting appropriate utilization of services, and facilitating safe and effective transitions across the continuum of care.

About the Position

This is a key nursing coordination role with responsibility for
Utilization Review and the Transitional Care (Swing Bed) Program. The ideal candidate will be organized, detail-oriented, and confident working collaboratively with physicians, clinical teams, patients, families, and external partners.

Key Responsibilities

• Coordinate and manage the Swing Bed/Transitional Care Program
• Conduct utilization reviews to ensure appropriate levels of care and optimize length of stay
• Review admissions for medical necessity and regulatory compliance
• Coordinate internal and external referrals and establish strong provider relationships
• Collaborate with physicians, case management, nursing, and interdisciplinary care teams
• Support comprehensive discharge planning and safe, timely transitions of care
• Complete pre-authorizations and follow up on denials and related payer requirements
• Monitor and maintain compliance with applicable regulatory, accreditation, and organizational standards
• Serve as a resource to clinical teams regarding utilization, care coordination, and regulatory requirements

Schedule

• Full-Time | 40 hours per week
• Monday–Friday | 1st Shift
• Occasional evenings or weekends as needed
• No travel required

Minimum Qualifications

• Current, unrestricted North Carolina Registered Nurse (RN) license
• BLS Certification
• Previous Utilization Review experience required
• Strong communication, organization, and care coordination skills
• Ability to manage multiple priorities while maintaining accuracy and attention to detail
• Demonstrated ability to collaborate effectively with physicians, clinical teams, patients, and external partners

Preferred Qualifications

• Experience coordinating a Swing Bed or Transitional Care Program
• Previous case management or discharge planning experience
• Hospital-based nursing experience
• Knowledge of healthcare regulatory, accreditation, and payer requirements

What We’re Looking For

The ideal candidate will bring:

• Excellent organizational and problem-solving skills
• Strong interpersonal and communication abilities
• The ability to build effective relationships across departments and organizations
• Knowledge of utilization management and regulatory requirements
• A commitment to patient-centered, high-quality care
• A collaborative, professional, and team-oriented approach

Employment Requirements

• Must meet applicable vaccination requirements
• Commitment to patient confidentiality, compliance, and professional standards
• Background check and drug screening required upon offer