Registered Nurse (RN) Utilization Review

Registered Nurse (RN) Utilization Review Case Manager

Join our team as a Registered Nurse (RN) Utilization Review Case Manager. This full-time position offers the opportunity to work remotely while ensuring appropriate use of hospital services and admissions.

Job Description

• Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions, and extended hospital stays.
• Reports to the Director of Case Management.
• Establishes and maintains efficient methods of ensuring the medical necessity and appropriateness of hospital admissions.
• Performs concurrent reviews for patients to ensure that extended stays are medically justified and documented in patients' medical records.
• Calculates the lengths of stay and continued-stay days for patients.
• Maintains a liaison with the Social Service Department to facilitate timely discharge planning.
• Processes claim denials and follows up.
• Works closely with Revenue Integrity and Parallon on denied claims.
• Manages UR for observation patients.
• Performs other duties as assigned.

Requirements

• Current Registered Nurse (RN) license.
• Associate's degree or RN Diploma in Nursing; Bachelor's degree in nursing or related healthcare field is required.
• Three years' experience in acute care, case management, or related healthcare field is required.
• Two years' experience in utilization review is required.
• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.

Benefits

• Medical, dental, and vision coverage.
• 401(k) retirement plan.
• Generous paid time off (PTO).
• PTO cash-out opportunities.
• PTO donation program.
• Tuition reimbursement (for qualifying candidates).
• Employee Assistance Program - support for mental, physical, and financial wellness.
• Employee recognition and awards programs.

About Our Health System

Maria Parham Health is a 98-bed hospital located in Henderson, NC, and a proud member of Lifepoint Health—a leading, diversified healthcare delivery network. With hospitals and care facilities nationwide, Lifepoint is committed to making communities healthier by supporting caregivers and enhancing care quality across the country.

Whether you're just starting your career or looking for your next opportunity, Maria Parham is a place where your experience matters—from day one.

Equal Opportunity Employer

Maria Parham Health is an Equal Opportunity Employer. We are committed to a diverse and inclusive workplace and comply with all applicable laws prohibiting discrimination and harassment in employment. Lifepoint Health is a leader in community-based care and driven by a mission of making communities healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.