Description

University of Kentucky

Equal Employment Opportunity/M/F/disability/protected veteran status.

Posting Details Posting Details Job TitleUtilization Management Reviewer/UKHCRequisition NumberRE51849Working TitleUtilization Management ReviewerDepartment NameH4025:Revenue IntegrityWork LocationLexington, KYGrade Level11Salary Range$54,080-95,056/yearType of PositionStaffPosition Time Status Full-TimeRequired EducationADNClick here for more information about equivalencies:https://hr.uky.edu/employment/working-uk/equivalenciesRequired Related Experience5 yrsRequired License/Registration/CertificationRegistered Nurse (RN)Physical RequirementsThe physical conditions of this position include; regularly sitting at a computer workstation for extended periods of time with repetitive motions (such as typing); occasionally lifting, pushing, and/or pulling objects up to 10lbsShiftNight shift weekdays, weekends and holidays.Job SummaryThis position works as a member of the multidisciplinary team with social workers, patient care facilitators, financial counselors, and ancillary staff to actively manage and coordinate those functions associated with third party payer certification, appropriate utilization of health services, and some aspects of discharge planning.

This is a hybrid position.
There is an internal candidate being considered.brSkills / Knowledge / AbilitiesThe ideal candidate will possess strong interpersonal, leadership, organizational, and written/verbal communication skills. General knowledge of criteria for accessing appropriate utilization of resources in the hospital is necessary. Exceptional planning and organizational skill. Effective written and verbal communication skills. General knowledge of criteria utilized by third party payers for admission and continued stay authorizations is necessary. General knowledge of Medicare, Medicaid, and third party payer reimbursement issues is necessary.Does this position have supervisory responsibilities? NoPreferred Education/ExperienceADN with 5 years direct patient care experience.Deadline to Apply01/15/2026Our University CommunityWe 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.

Posting Specific Questions

Required fields are indicated with an asterisk (*).

1. * Do you have a current Kentucky Registered Nurses license or are you eligible to obtain one by date of hire?
   • Yes
   • No
2. * Please indicate your years of paid work experience in utilization management.
   • None
   • More than 0, through 1 year
   • More than 1 year, through 3 years
   • More than 3 years, through 5 years
   • More than 5 years
3. * Do you have knowledge of Medicare guidelines?
   • Yes
   • No
4. * Do you have experience in working with the Medicare denial process?
   • Yes
   • No

Applicant Documents
Required Documents

1. Resume

Optional Documents

PI281258702