Utilization Review Nurse (Non-Exempt)

CarolinaEast•New Bern, NC

About The Position

Under the direction of the Utilization Review Manager and Physician Advisor, the Utilization Review Registered Nurse (UR-RN) assists in administering utilization review functions. The UR-RN validates documentation in the medical record and applies utilization review criteria, clinical knowledge and assessment, and payer-specific rules and guidance to determine the appropriateness of inpatient and observation services. CarolinaEast Health System provides care across the Coastal Carolina region through a 350-bed, full-service medical center and physician practices across four counties. The organization employs more than 3,200 team members and emphasizes high-quality, compassionate care in a community-centered environment.

Requirements

Graduate from an accredited School of Nursing.
Hold a current RN license with the North Carolina State Board of Nursing.
Ability to work independently.
Good written and oral communication skills and analytical skills.
Ability to research, interpret, and develop recommendations.
Ability to perform and complete multiple tasks within reasonable time constraints.
Computer skills, including Microsoft Word, Excel, or other word-processing software.

Nice To Haves

Minimum of five years of clinical experience preferred.
Insurance or payer experience preferred.
Prior utilization review experience preferred.

Responsibilities

Assist in administering utilization review functions under the direction of the Utilization Review Manager and Physician Advisor.
Validate documentation contained in the medical record.
Apply utilization review criteria, clinical knowledge and assessment, and payer-specific rules and guidance to determine the appropriateness of inpatient and observation services.
Deliver outstanding customer service consistent with CarolinaEast's Standards of Excellence.