Registered Nurse, Utilization Management
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Job Description
Utilization Management RN reviewing medical necessity and admission status at UVA Health. Supporting payer authorization, regulatory compliance, and patient-centered outcomes.
Responsibilities:
- Review patient admissions to determine medical necessity and appropriate level of care
- Evaluate whether patients are placed in the correct admission status and timeframe
- Ensure adherence to CMS, Medicare, and payer-specific guidelines
- Communicate with physicians, nurses, and care teams to clarify or adjust patient status as needed
- Engage with insurance payers to support authorization and reimbursement processes
- Identify and act on opportunities to maintain compliance and optimize outcomes
- Independently assess medical necessity and collaborate across care teams
- Support regulatory compliance, reimbursement integrity, and patient-centered outcomes
Requirements:
- Bachelor of Science in Nursing from accredited nursing program
- 2 years acute care hospital experience
- Licensed to Practice as a Registered Nurse in the Commonwealth of Virginia required
- Proficient communicative, auditory and visual skills
- Attention to detail
- Ability to write legibly
Benefits:
- Comprehensive Benefits Package: Medical, Dental, and Vision Insurance
- Paid Time Off
- Long-term and Short-term Disability
- Retirement Savings
- Health Saving Plans
- Flexible Spending Accounts
- Certification and education support
- Generous Paid Time Off
- Relocation assistance may be available for qualified candidates
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