Utilization Review RN: Care Coordination Expert

UofL Health, Inc.; Louisville (KY); On-site; USD 75,000 - 95,000; Full time

Job summary

UofL Health, Inc. is seeking a dedicated RN Utilization Review to support medical necessity reviews and concurrent utilization management in Louisville. You will collaborate with physicians, case managers, and payors to optimize admissions and discharge planning.

The role requires RN licensure in Kentucky, 2 years RN experience, and familiarity with MCG guidelines and CMS standards. This on-site position supports patient care coordination and financial accountability across a major health system.

Qualifications

• RN with ADN/BSN options and venous/functional exposure to utilization review.
• Two years of RN experience required; case management/utilization exp preferred.
• Knowledge of payer requirements and CMS/Joint Commission guidelines.

Responsibilities

• Performs admission and concurrent utilization review to determine medical necessity for admission, continued stay, and discharge.
• Communicates with physicians and case managers regarding payor approvals/denials.
• Documents clinical information in Case Management Software and ensures timely reviews.
• Educates physicians, patients and staff on payors, documentation and compliance issues.
• Maintains regulatory knowledge of commercial/government payers and CMS conditions of participation.

Skills

Utilization Review

Case management

Nursing (RN)

Attention to detail

Communication

Education

BSN preferred

ADN accepted

Tools

MCG Care Guidelines

Case Management Software

EMR

Job description

UofL Health, Inc. is seeking a dedicated RN Utilization Review to support medical necessity reviews and concurrent utilization management in Louisville. You will collaborate with physicians, case managers, and payors to optimize admissions and discharge planning.

The role requires RN licensure in Kentucky, 2 years RN experience, and familiarity with MCG guidelines and CMS standards. This on-site position supports patient care coordination and financial accountability across a major health system.