Nurse Utilization Review Specialist III

About This Role

This specialist role involves evaluating newly admitted patients to ensure appropriate hospitalization, accurate documentation, and correct level of care designation. The position serves as a key liaison between medical staff, patients, and insurance providers to ensure quality patient care and proper reimbursement, while also collaborating on discharge planning and coordinating post-acute services.

Responsibilities

• Assess all newly admitted patients for appropriate hospitalization, accurate documentation, proper order entry, and correct level of care designation
• Conduct daily reviews for patients whose payer requires continued review, ensuring medical necessity is consistently documented and communicated
• Collaborate with physicians regarding patient status, level of care, and necessary documentation to meet medical necessity and payer requirements
• Serve as a liaison with insurance companies, Medicare, and Medicaid to provide timely updates, submit required medical information, and secure authorizations for continued hospitalization
• Work closely with nursing staff and weekend social workers to assess patient needs and coordinate home health services, durable medical equipment (DME), and other post-discharge resources
• Partner with the healthcare team to facilitate effective communication, ensure continuity of care, and support safe and efficient patient transitions
• Perform other duties as assigned

Requirements

• Associate Degree - ADN
• 3-5 years of paid experience in the same related field
• Nursing License

Important Details

• Schedule: Day shift
• Employment type: Part time
• Work format: Hybrid eligible, with approval
• Team: Review Department

About the Company

At UK St. Claire, staff are considered the greatest asset in the mission to create a healthier and more prosperous population. The organization strives to foster the talent and potential of its employees and prioritizes safe working conditions and equal compensation rates to ensure continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals.