Utilization Review Specialist (RN/Behavioral Health)

Universal Health Services; Raleigh (NC); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Loan Forgiveness Program

Tuition Reimbursement

401(k) with company match

Career development opportunities

Benefits Website

Job summary

Universal Health Services in Raleigh, NC seeks a Registered Nurse for utilization management in inpatient and outpatient settings. You will coordinate and document patient care, and liaise with third‑party payors to support appropriate treatment; Monday–Friday (PRN).

The role emphasizes high‑quality patient care, case reviews, and effective communication within the treatment team. RN licensure required; bachelor’s degree in nursing preferred.

Qualifications

• Bachelor degree in Nursing; RN licensure required.
• One year Utilization Management experience in hospital setting.
• Knowledge of behavioral managed care and clinical assessment.

Responsibilities

• Coordinate utilization and documentation of services for admitted patients.
• Review admission, continued stay, and discharge planning.
• Submit appeals to third party payors with supporting data.
• Call discharge information to insurance within 24 hours of discharge.
• Maintain logs and records of the Utilization Review department.
• Communicate insurance information to treatment team.
• Attend treatment team meetings to discuss acuity and payor needs.

Skills

DSM methodology

Telephone etiquette

Communication skills

Interpersonal skills

Time management

Education

Bachelor in Nursing

Master's degree preferred

Job description

Universal Health Services in Raleigh, NC seeks a Registered Nurse for utilization management in inpatient and outpatient settings. You will coordinate and document patient care, and liaise with third‑party payors to support appropriate treatment; Monday–Friday (PRN).

The role emphasizes high‑quality patient care, case reviews, and effective communication within the treatment team. RN licensure required; bachelor’s degree in nursing preferred.