Utilization Review/Patient Care Coordinator (FT)

Registered Nurse – Utilization Review / Patient Care Coordinator Ashe Memorial Hospital | West Jefferson, NC Full-Time | Monday–Friday | 1st Shift Coordinate Care. Improve Outcomes. Make a Difference. At Ashe Memorial Hospital, we are committed to our mission: “To meet the needs of the community by delivering patient-centered, high-quality health care.” We are proud to be recognized as Ashe’s Best Place to Work for 2022, 2023, 2024, and 2025, reflecting our commitment to creating a supportive, collaborative environment where our team members can thrive. We are seeking an experienced Registered Nurse – Utilization Review / Patient Care Coordinator to join our team. This position plays a vital role in coordinating patient care, supporting appropriate utilization of services, and facilitating safe and effective transitions across the continuum of care. 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. Key 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 Schedule Full-Time | 40 hours per week Monday–Friday | 1st Shift Occasional evenings or weekends as needed No travel required Minimum Qualifications 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 Preferred Qualifications 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 What We’re Looking For The ideal candidate will bring: 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 Employment Requirements Must meet applicable vaccination requirements Commitment to patient confidentiality, compliance, and professional standards Background check and drug screening required upon offer #J-18808-Ljbffr Ashe Memorial Hospital