Registered Nurse - Utilization Review / Patient Care Coordinator

About the role

Ashe Memorial Hospital in West Jefferson, NC is looking for an experienced Registered Nurse to act as Utilization Review / Patient Care Coordinator. The role coordinates patient care, supports appropriate use of services and helps patients move safely between settings. It is a full-time, Monday-to-Friday, first-shift position (40 hours per week) with occasional evenings or weekends; no travel is required.

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 build strong provider relationships
• Work with physicians, case management, nursing and interdisciplinary teams
• Support discharge planning and safe, timely transitions of care
• Complete pre-authorizations and follow up on denials and payer requirements
• Maintain compliance with regulatory, accreditation and organizational standards
• Serve as a resource to clinical teams on utilization, care coordination and regulations

Required profile

• Current, unrestricted North Carolina RN license
• BLS certification
• Previous utilization review experience (required)
• Ability to collaborate with physicians, clinical teams, patients and external partners
• Must meet vaccination requirements; background check and drug screening required on offer

Preferred qualifications

• Experience coordinating a Swing Bed or Transitional Care Program
• Case management or discharge planning experience
• Hospital-based nursing experience
• Knowledge of regulatory, accreditation and payer requirements