RN Utilization Review

Cone Health Medical Group; Greensboro (NC); On-site; USD 85,000 - 110,000; Full time

Job summary

Cone Health Medical Group is seeking a Registered Nurse (RN) for Utilization Review to monitor and optimize patient care utilization. Working with minimal supervision, you will oversee projects and provide expert guidance on efficient resource use aligned with patient needs and regulations.

The role requires a Bachelor's degree in Nursing, at least 2 years of RN experience, and NC (or Compact state) licensure, plus current CPR/BLS and national specialty certification.

Qualifications

• Bachelor's of Nursing Degree required.
• 2 years of cumulative experience as practicing RN required.
• RN license in NC or a Compact state required.
• BLS (CPR) from American Red Cross or AHA Healthcare Provider required.
• National certification in clinical specialty area required.

Responsibilities

• Reviews patient needs and conditions to deliver nursing care within the assigned unit to ensure that every patient receives the direct and proper care needed.
• Reviews patient records and develops strategies to optimize healthcare resource utilization.
• Prepares reports and examines trends to identify opportunities for efficiency and quality improvements.
• Applies knowledge of utilization review methodologies to serve as a resource for training and ensuring compliance with regulations.
• Seeks guidance from senior management as needed to clarify coverage and utilization criteria.
• Performs other duties as assigned.

Skills

Utilization review

Nursing care

Report writing

Training/mentoring

Education

Bachelor's degree in Nursing

Job description

A Registered Nurse (RN) 3 Utilization Review monitors and evaluates patient care utilization. Working under minimal supervision, this role manages projects and processes within the utilization review group and provides expert counsel to the organization on the optimal use of healthcare resources in alignment with patient needs and regulatory compliance.

Essential Job Functions

• Reviews patient needs and conditions to deliver nursing care within the assigned unit to ensure that every patient receives the direct and proper care needed.
• Reviews patient records and develops strategies to optimize healthcare resource utilization.
• Prepares reports and examines trends to identify opportunities for efficiency and quality improvements.
• Applies knowledge of utilization review methodologies to serve as a resource for training and ensuring compliance with regulations.
• Seeks guidance from senior management as needed to clarify coverage and utilization criteria.
• Performs other duties as assigned.

Education

• Required: Bachelor's of Nursing Degree.

Experience

• Required: 2 years of cumulative experience as practicing RN.

Licensure/Certification/Listing

• Required: Registered Nurse license in North Carolina or a Compact state.
• BLS (CPR)-American Red Cross or AHA Healthcare Provider.
• National certification in clinical specialty area.