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 assists with administration of utilization review functions. The nurse validates documentation in medical records and applies utilization review criteria, clinical knowledge and assessment, and payer-specific rules and guidance to determine the appropriateness of inpatient and observation services.
Requirements
- Graduate from an accredited School of Nursing.
- 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 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 administration of utilization review functions.
- Validate documentation contained in medical records.
- Apply utilization review criteria, clinical knowledge and assessment, and payer-specific rules and guidance to determine the appropriateness of inpatient and observation services.
- Deliver customer service that upholds CarolinaEast's Standards of Excellence.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
