Utilization Review RN: Elevate Patient Care & Efficiency

Capital Health

Northern (KY)

Hybrid

USD 82,000 - 107,000

Full time

3 days ago

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Benefits offered by this job

Medical Plan

Prescription drug coverage

Dental Plan

Vision Plan

Flexible Spending Account (FSA)

Job summary

Capital Health is seeking an experienced RN for Utilization Management to optimize patient care, length of stay, and resource use. This role emphasizes collaboration with the medical team, payer interactions, and adherence to CMS guidelines.

Strong clinical nursing background and UR/QA experience are essential, with a focus on quality and cost efficiency. The position requires an associate degree in nursing, RN license, and experience in utilization review or discharge planning.

Qualifications

Associate degree in nursing required.
RN license required.
Five years’ clinical nursing experience plus three years in quality management/utilization review/discharge planning.

Responsibilities

Perform chart reviews to assess quality, timeliness and appropriateness of care.
Conduct admission reviews for Medicare/Medicaid and private payers.
Refer cases to UR physician advisor for review and determination.
Engage care team to resolve progression of care barriers and optimize resource use.
Participate in performance improvement activities and daily huddles.