Utilization Review/Patient Care Coordinator (FT)

Ashe Memorial Hospital•Jefferson, NC

1d•Onsite

About The Position

This is a key nursing coordination role with responsibility for Utilization Review and the Transitional Care (Swing Bed) Program. The ideal candidate will be organized, detail-oriented, and confident working collaboratively with physicians, clinical teams, patients, families, and external partners.

Requirements

Current, unrestricted North Carolina Registered Nurse (RN) license
BLS Certification
Previous Utilization Review experience required
Strong communication, organization, and care coordination skills
Ability to manage multiple priorities while maintaining accuracy and attention to detail
Demonstrated ability to collaborate effectively with physicians, clinical teams, patients, and external partners
Must meet applicable vaccination requirements
Commitment to patient confidentiality, compliance, and professional standards
Background check and drug screening required upon offer

Nice To Haves

Experience coordinating a Swing Bed or Transitional Care Program
Previous case management or discharge planning experience
Hospital-based nursing experience
Knowledge of healthcare regulatory, accreditation, and payer requirements
Excellent organizational and problem-solving skills
Strong interpersonal and communication abilities
The ability to build effective relationships across departments and organizations
Knowledge of utilization management and regulatory requirements
A commitment to patient-centered, high-quality care
A collaborative, professional, and team-oriented approach

Responsibilities

Coordinate and manage the Swing Bed/Transitional Care Program
Conduct utilization reviews to ensure appropriate levels of care and optimize length of stay
Review admissions for medical necessity and regulatory compliance
Coordinate internal and external referrals and establish strong provider relationships
Collaborate with physicians, case management, nursing, and interdisciplinary care teams
Support comprehensive discharge planning and safe, timely transitions of care
Complete pre-authorizations and follow up on denials and related payer requirements
Monitor and maintain compliance with applicable regulatory, accreditation, and organizational standards
Serve as a resource to clinical teams regarding utilization, care coordination, and regulatory requirements