Utilization Review Nurse (Non-Exempt)

CarolinaEast Health; New Bern (NC); On-site; USD 75,000 - 105,000; Full time

Job summary

CarolinaEast Health System in New Bern, NC, seeks a Utilization Review Registered Nurse (UR-RN) to support utilization review activities under the direction of the Utilization Review Manager and Physician Advisor. The UR-RN validates medical record documentation and applies clinical criteria and payer rules to determine the appropriateness of inpatient and observation services.

The role emphasizes independent work, strong communication, and analytical skills to ensure efficient care delivery and

Qualifications

• Graduate from an accredited School of Nursing.
• Current RN license with North Carolina State Board of Nursing.
• Minimum of five years of clinical experience; insurance/payer experience or prior utilization review experience preferred.
• Ability to work independently.
• Good written, oral communication and analytical skills.
• Ability to research, interpret, and develop recommendations.
• Ability to perform and complete multiple tasks within reasonable time constraints.
• Possess computer skills including Microsoft Word, Excel or other word processing software.
• Deliver outstanding customer service that upholds CarolinaEast's Standards of Excellence.

Responsibilities

• Assist in administration of utilization review functions.
• Validate documentation in the medical record.
• Apply utilization review criteria and payer-specific rules/guidance.
• Determine appropriateness of inpatient and observation services.

Skills

Analytical skills

Written and verbal communication

Research and recommendations

Education

Nursing degree/diploma

RN license (NC)

Tools

Microsoft Word

Excel

Job description

Job Summary:Under the direction of the Utilization Review Manager and Physician Advisor, the Utilization Review Registered Nurse (UR-RN) assists in administration of utilization review functions. The UR RN will validate the documentation contained in the medical record. The UR RN will apply utilization review criteria, clinical knowledge/assessment, and application of payer specific rules/guidance to determine appropriateness of inpatient and observation services.

About CarolinaEast Health System

CarolinaEast Health System is committed to providing high quality, compassionate care across the Coastal Carolina region. At the heart of our system is a 350-bed, full-service medical center equipped with a comprehensive range of inpatient and outpatient services, utilizing the latest medical technologies. We employ over 3,200 dedicated team members and operate physician practices across various specialties in four counties. Our employees foster a culture of excellence that ensures our patients receive the same high level of care found at larger medical centers, all while maintaining a friendly, community-centered atmosphere throughout our facilities. CarolinaEast offers a robust benefits package to all full-time employees, as well as benefits for part-time plus and part-time staff. We are proud to be the first medical center in North Carolina recognized as a Cardiovascular Center of Excellence by the American College of Cardiology and the American Heart Association. Additionally, we are honored to be named one of America’s Best-In-State Hospitals by Newsweek, among numerous other prestigious accolades.

Minimum Requirement's:

• Graduate from an accredited School of Nursing.
• Current RN license with North Carolina State Board of Nursing.
• Minimum of five years of clinical experience preferred. Insurance/payer experience/prior utilization review experience preferred.
• Ability to work independently.
• Good written, oral communication and analytical skills required.
• Ability to research, interpret, and develop recommendations.
• Ability to perform and complete multiple tasks within reasonable time constraints.
• Possess computer skills including Microsoft Word, Excel or other word processing software.
• Deliver outstanding customer service that upholds CarolinaEast's Standards of Excellence.