Utilization Review RN: Care Coordination & Compliance

University Medical Center, Inc.; Cincinnati (OH); On-site; USD 75,000 - 95,000; Full time

Job summary

UofL Health in Louisville, KY is seeking an experienced Utilization Review RN to support the Utilization Management process, including admission and concurrent reviews, and communications with payors and physicians.

The role emphasizes compliance with MCG criteria, accurate documentation, and collaboration with interdisciplinary teams to ensure appropriate care levels and financial accountability.

Qualifications

• ADN or Associate’s degree in nursing (Required).
• BSN preferred or enrollment within three years of employment.
• Active Kentucky RN license or compact license.
• Case Management Certification preferred.
• Two years’ RN experience; case management/utilization management preferred.

Responsibilities

• Promotes timely admission and concurrent utilization review for designated services.
• Certifies medical necessity for admission, continued stay, and discharge.
• Communicates with payors and physicians to obtain authorizations.
• Documents clinical information and authorization details in Case Management Software.
• Identifies delays impacting timeliness and coordinates resources as needed.
• Educates physicians and staff on payors, documentation, and compliance issues.
• Assists with regulatory and payer requirements and care coordination processes.

Skills

Attention to detail

Communication skills

MS Word

Excel

Outlook

EMR systems

Education

ADN or Associate’s degree in nursing

Bachelor of Science in Nursing (preferred)

RN licensure (Active)

Tools

MS Word

Excel

Outlook

EMR

Job description

UofL Health in Louisville, KY is seeking an experienced Utilization Review RN to support the Utilization Management process, including admission and concurrent reviews, and communications with payors and physicians.

The role emphasizes compliance with MCG criteria, accurate documentation, and collaboration with interdisciplinary teams to ensure appropriate care levels and financial accountability.