Utilization Review RN: Impactful Care & Compliance

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

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