Utilization Review/Patient Care Coordinator (FT)

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.

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.

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

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

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

Skills

• Excellent organizational and problem-solving skills
• Strong interpersonal and communication abilities
• Ability to build effective relationships across departments and organizations
• Knowledge of utilization management and regulatory requirements
• Commitment to patient-centered, high-quality care
• Collaborative, professional, and team-oriented approach

Schedule

• Full-Time | 40 hours per week
• Monday–Friday | 1st Shift
• Occasional evenings or weekends as needed
• No travel required

Employment Requirements

• Must meet applicable vaccination requirements
• Commitment to patient confidentiality, compliance, and professional standards
• Background check and drug screening required upon offer