Utilization Review Nurse (Non-Exempt), Utilization Review
: Job Details :

Job DescriptionAbout CarolinaEast Medical CenterCarolinaEast Health System is dedicated to quality and compassionate care across the Coastal Carolina region. The flagship of the health system is a 350 bed full service medical center housing a complete complement of inpatient and outpatient services with the latest technology. CarolinaEast Health System employs 2,500 dedicated team members. We have physician practices in various specialties spanning four counties. Our employees create a culture of excellence that connects our patients to the same level of care that is usually found at larger medical centers while maintaining a friendly, community feel throughout our facilities. CarolinaEast offers a comprehensive benefits package to all full time employees as well as benefits to part time plus and part time employees.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.Minimum Requirements: 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.