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Utilization Manager
Duke CareersUtilization Manager at Duke Health responsible for patient class assignment and clinical review documentation. Collaborating with healthcare teams to ensure accurate assessments and effective communication.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient class assignment, clinical review documentation, and denials management within a healthcare setting. Holds a BSN and relevant certifications, ensuring compliance with state licensure and industry standards.
Highest-signal resume keywords
BSNCase Management Certification (ACM, CCM or ANCC)Current RN Licensure in NCBLS CertificationAcute Clinical Practice Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Patient Class AssignmentClinical Review DocumentationDenials ManagementAuthorization ValidationInitial Review and Continued Stay Reviews
Soft Skills
CollaborationEducation and Training
Certifications & Qualifications
Case Management Certification (ACM, CCM or ANCC)BLS Certification
Industry Keywords
Healthcare Team CollaborationDenials AdjudicationLength of Stay (LOS) ManagementPeer-to-Peer Conversations
About the role
Key responsibilities & impact- Assesses for accuracy in the assignment of patient class (status).
- Supports the medical chart audit process by ensuring accurate, timely, and informative clinical review documentation.
- Supports denials management by documenting activities related to denials adjudication.
- Collaborates with members of the healthcare team.
- Validates authorization for all bedded patients.
- Conducts initial review and continued stay reviews as designated.
- Establishes and communicates estimated LOS and expected discharge date.
- Facilitates mitigation of denials and peer-to-peer conversations.
- Provides formal and informal education to physicians and healthcare team.
Requirements
What you’ll need- BSN required
- Minimum of three years recent acute clinical practice or related health care experience.
- Requires Case Management Certification (ACM, CCM or ANCC) within 2 years of hire.
- Must have current or compact RN licensure in state of NC.
- BLS certification required.
Benefits
Comp & perks- Relocation Assistance (based on eligibility)