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Nurse Utilization Review Specialist III
UK King's Daughters Workforce Institute. Evaluate newly admitted patients for appropriate hospitalization, documentation accuracy, order entry, and level-of-care designation .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient evaluation, documentation accuracy, and collaboration with healthcare professionals to ensure appropriate hospitalization and continuity of care. Proficient in securing authorizations and coordinating post-discharge resources while maintaining compliance with insurance requirements.
Highest-signal resume keywords
Nursing LicensePatient EvaluationMedical Necessity DocumentationCollaboration with PhysiciansInsurance Liaison
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Order EntryLevel-of-Care DesignationDaily Patient ReviewsHome Health Services CoordinationDurable Medical Equipment Management
Soft Skills
CommunicationCollaborationFacilitation
Certifications & Qualifications
Associate Degree - ADN
Industry Keywords
MedicareMedicaidPayer ReviewContinuity of CarePatient Transitions
About the role
Key responsibilities & impact- Evaluate newly admitted patients for appropriate hospitalization, documentation accuracy, order entry, and level-of-care designation
- Conduct daily reviews for patients requiring continued payer review
- Ensure medical necessity is documented and communicated
- Collaborate with physicians on patient status, level of care, and required documentation
- Liaise with insurance companies, Medicare, and Medicaid
- Submit medical information and secure authorizations for continued hospitalization
- Collaborate with nursing staff and weekend social workers
- Coordinate home health services, durable medical equipment, and post-discharge resources
- Facilitate communication, continuity of care, and safe patient transitions
- Perform other duties as assigned
Requirements
What you’ll need- Associate Degree - ADN
- 3-5 years of experience
- Nursing License
- Equivalent combinations of education and experience may be considered
- All experience must be paid and in the same related field
- Part-time and PRN experience prorated based on hours worked per week
- Volunteer work and internships for academic credit are not counted
- Ability to perform the stated physical and working-condition requirements