Utilization Review Nurse

At UK St. Claire, our staff is our greatest asset in the mission to create a healthier and more prosperous population. We strive to foster the talent and potential of our employees and prioritize safe working conditions and equal compensation rates to ensure that continual growth is possible. UKSC is a nurturing workplace for all healthcare professionals. We invite you to explore our current job openings and see if our opportunities could be the right fit for you.

Job Description :
Job Summary

Responsible for reviewing electronic medical records, retrieving and verifying data for external regulatory reporting, and completing required forms according to established guidelines. Ensures accuracy and timeliness of data collection, performs audits, and generates reports for clinical and ancillary teams. Coordinates with quality improvement teams to collect and analyze data, supporting compliance with regulatory and accreditation requirements. Educates staff on reporting standards and assists with interpretation of data and reports. Supports utilization review processes by planning, analyzing data, and setting goals to ensure appropriate reimbursement and adherence to guidelines.

Essential Functions

• Abstracts and assembles data from printed and online sources.

• Reviews charts post-listing, post-transplant, and at annual follow-ups for UNOS reporting.

• Captures and enters data fields according to UNOS guidelines.

• Reviews and verifies data accuracy with transplant coordinators and physicians.

• Edits and validates printed and computerized data for accuracy.

• Performs audits and verifies data for UNOS, survival, and external reporting.

• Generates and interprets reports for physicians, nursing, and ancillary services.

• Coordinates with teams to collect and report quality improvement data.

• Educates staff on UNOS reporting requirements and database elements.

• Performs other duties as assigned.

Education Requirement

Bachelor's degree in nursing, or a related field

Experience Requirement

2+ years of experience in nursing, or a relevant area

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

Current and active Registered Nurse (RN) license

Working Conditions

A. Lifting, pushing, and/or pulling objects up to 50lbs: 2. Occasional (< 10% of the time)

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

C. Standing or walking with objects up to 10lbs: 2. Occasional (< 10% of the time)

D. Standing or walking with objects up to 25lbs: 1. Never

E. Sitting at computer workstation for extended periods: 3. Intermittent (10% - 50% 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 (10% - 50% 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: 2. Occasional (< 10% of the time)

O. Radiation: 1. Never

P. Burns: 1. Never

Q. Cuts/Punctures: 2. Occasional (< 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 intermittent sitting at a computer workstation for extended periods of time; and performing tasks with repetitive motions (such as typing); and occasionally standing or walking with objects weighing up to 10 pounds; and lifting, pushing, and/or pulling objects weighing up to 50 pounds. Also involves some exposure to risk of injury from moving, lifting, or positioning patients, equipment, or materials.

Additional Job Descriptions

N/A

Department :
Case Management

Shift :
Days (United States of America)

Time Type:
Full time

Address :
222 Medical Circle

City, State :
Morehead, Kentucky