Registered Nurse, Utilization Management

🔥 2 minutes ago

⚔️ Virginia – Remote

⚔️ Virginia – Remote

💵 $76.4k - $122.2k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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UVA Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

📚 Education

🔬 Science

💰 $100k Grant - UVA Health on 2025-01

Healthcare • Education • Science

UVA Health is an integrated academic health system aligned with the University of Virginia that combines clinical care, education, and research. It comprises the flagship University Medical Center (a 600‑bed academic medical center in Charlottesville with a Level I trauma center, Level IV NICU, and an NCI‑designated Comprehensive Cancer Center), the UVA School of Medicine and School of Nursing, UVA Physicians Group, a top-ranked children’s hospital, three community hospitals, a specialty rehabilitation hospital, and an integrated network of primary and specialty care clinics across Virginia. UVA Health operates both tertiary/academic and community care sites and supports medical education, training programs, and clinical research.

📋 Description

• 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