Utilization Review RN: Optimize Care & Authorizations

University Medical Center, Inc.; Cincinnati (OH); On-site; USD 65,000 - 85,000; Full time

Job summary

UofL Health is seeking a Utilization Review RN to support admission and concurrent reviews, ensuring medical necessity and appropriate levels of care. The role involves collaborating with physicians, case managers, and payors to optimize patient outcomes and financial accountability.

Responsibilities include documenting in Case Management Software, educating providers on guidelines, and ensuring compliance with regulatory and contract requirements to enable efficient, high-quality care.

Qualifications

• RN with current license and strong knowledge of utilization review principles.
• ADN or BSN required, BSN preferred with timeline.
• Experience in case management/utilization management is desirable.

Responsibilities

• Promotes optimal management of clinical resources through admission and concurrent UM reviews.
• Evaluates records to identify delays affecting patient care and coordinates with care teams.
• Communicates with third-party payers to obtain authorizations and documents approvals.
• Educates physicians and staff on payor guidelines, documentation, and compliance issues.

Skills

Communication

Attention to detail

RN licensure

Critical thinking

Education

ADN

BSN

Tools

Case Management Software

Job description

UofL Health is seeking a Utilization Review RN to support admission and concurrent reviews, ensuring medical necessity and appropriate levels of care. The role involves collaborating with physicians, case managers, and payors to optimize patient outcomes and financial accountability.

Responsibilities include documenting in Case Management Software, educating providers on guidelines, and ensuring compliance with regulatory and contract requirements to enable efficient, high-quality care.