Beyond Blue

Job Posting Title:

Nurse Utilization Review Specialist III

Requisition Number:

R-000005085

Department Name:

Review

Work Location:

UK Chandler Hospital, Pavilion H

Grade Level:

Type of Position:

Regular

Position Time Status:

Part time

Equivalency Link

https://hr.uky.edu/employment/working-uk/equivalencies

Shift:

Day (United States of America)

Job Description:

Job Summary

Responsible for evaluating all newly admitted patients to ensure appropriate hospitalization, documentation accuracy, order entry, and proper designation of level of care. Serves as a key liaison between physicians, nursing staff and weekend social workers, patients, insurance providers, and government payers to ensure quality patient care and proper reimbursement. Collaborates on discharge planning and coordinate post-acute services such as home health and durable medical equipment

Essential Functions

• Assesses all newly admitted patients for appropriate hospitalization, accurate documentation, proper order entry, and correct level of care designation.

• Conducts daily reviews for patients whose payer requires continued review, ensuring medical necessity is consistently documented and communicated.

• Collaborates with physicians regarding patient status, level of care, and necessary documentation to meet medical necessity and payer requirements.

• Serves as a liaison with insurance companies, Medicare, and Medicaid to provide timely updates, submit required medical information, and secure authorizations for continued hospitalization.

• Works 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.

• Partners with the healthcare team to facilitate effective communication, ensure continuity of care, and support safe and efficient patient transitions.

• Performs other duties as assigned.

Education Requirement: Associate Degree - ADN

Experience Requirement: 3-5 Years

An equivalent combination of education and experience may be considered. All experience must be paid and in the same related field. Part-time and PRN experience will be prorated based on hours worked per week. Volunteer work and internships for academic credit are not counted.

Certifications & Licensures: Nursing License

Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs:1. Never (< 10% of the time)

B. Lifting, pushing, and/or pulling objects over 50lbs:1. Never

C. Standing or walking with objects up to 10lbs:3. Intermittent (10% - 50% of the time)

D. Standing or walking with objects up to 25lbs:1. Never (< 10% of the time)

E. Sitting at the computer workstation for extended periods:3. Intermittent (100% of the time)

F. Risk of back injury from moving, lifting or positioning patients, equipment, or materials:2. Occasional (< 10% of the time)

G. Repetitive motion:3. Intermittent (100% of the time)

H. Working at heights above 4 feet:1. Never

I. Working in confined spaces:1. Never

J. Risk of injuries from use of equipment on the job:2. Occasional (< 10% of the time)

K. Job-related travel:2. Occasional (< 10% of the time)

L. Loud noises:1. Never

M. Temperature extremes:1. Never

N. Hazardous chemicals and fumes including waste:1. Never (< 10% of the time)

O. Radiation:1. Never

P. Burns:1. Never

Q. Cuts/Punctures:1. Never (< 10% of the time)

R. Bloodborne/airborne pathogens:2. Occasional (< 10% of the time)

S. Recombinant DNA or viral vectors:1. Never

T. Combative/violent people:1. Never

U. Animal handling (including carcasses):1. Never

V. Please specify other(s) and amount of exposure (i.e. Occasional, Intermittent or Regular): N/A

Physical Demands

This position requires sitting at a computer workstation for extended periods of time; performing tasks with repetitive motions (such as typing); and intermittent standing or walking with objects weighing up to 10 pounds.

Our University Community

We value the well-being of each of our employees and are dedicated to creating a healthy place for everyone to work, learn and live. In the interest of maintaining a safe and healthy environment for our students, employees, patients and visitors, the University of Kentucky is a Tobacco & Drug Free campus.

The University follows both the federal and state Constitutions as well as all applicable federal and state laws on nondiscrimination. The University provides equal opportunities for qualified persons in all aspects of institutional operations and does not discriminate on the basis of race, color, national origin, ethnic origin, religion, creed, age, physical or mental disability, veteran status, uniformed service, political belief, sex, sexual orientation, gender identity, gender expression, pregnancy, marital status, genetic information or social or economic status.

Any candidate offered a position may be required to pass pre-employment screenings as mandated by University of Kentucky Human Resources. These screenings may include a national background check and/or drug screen.

Welcome

Purpose-driven work is behind every aspect of our mission to advance Kentucky – from its economy to its health and from its culture to its levels of educational attainment.

We're looking for talented, dedicated individuals to help us support this vital mission and make a difference in the lives of Kentuckians and beyond. Join us as we build a future grounded in service, collaboration and excellence, one where your talents help move our Commonwealth forward.

About Us

Beyond Blue Corporation, an affiliated entity of the University of Kentucky, is a strategic vehicle to support the university's growth. Beyond Blue is a nonprofit company that allows the university to abide by all public entity rules and laws while allowing leaders to have some separation and distinctiveness to focus on one core business. The UK Board of Trustees appoints the Beyond Blue Board of Directors and the directors of any of its subsidiary companies.