Utilization Review Nurse

Utilization Review Nurse

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Summary: This position facilitates utilization management processes to support the right care is provided at the right place at the right time. To accomplish these goals, the UR, Nurse applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary; in collaboration with the care team. This position provides third-party payers clinical information to assure reimbursement; and coordinating care with the treatment team, patient, family, and others. Communicates with physicians for appropriate documentation to support authorization of services.

Responsibilities: Patients/Families, Hospital staff, Medical staff, Community agencies, and Insurance Companies are served by conducting interpersonal relationships in a manner that projects a positive image of the department and hospital. All contacts with customers are friendly, helpful and courteous.

Qualifications

Education Requirements: Graduate from an accredited school of nursing, BSN preferred.

Professional Experience Requirement: Five (5) years of health care experience as a Registered Nurse.

Licensure/Registration/Certification: Licensed to practice as a Registered Nurse in the state of North Carolina.

Knowledge, Skills and Abilities Requirements: Strong assessment and critical thinking skills.

Physical Requirement: Standing, Walking, Sitting, Reaching, Talking, Seeing, Hearing, Tasting, Smelling, Carrying, Pushing, Pulling, Lifting, and Moving.