Utilization Review Nurse

1 week ago


Rocky Mount, North Carolina, United States UNC Health Care Full time
Job Summary

We are seeking a skilled Utilization Review Nurse to join our team at UNC Health Care. As a Utilization Review Nurse, you will play a critical role in ensuring the efficient use of hospital resources and ensuring timely reimbursement for services rendered.

Key Responsibilities
  • Collaborate with the healthcare team to identify appropriate utilization of hospital resources and ensure timely reimbursement for services rendered.
  • Utilize established criteria to confirm medical necessity for admission to the hospital, continued stay, and use of other hospital services.
  • Communicate with third-party payers to ensure authorization for services is obtained and complete necessary appeals for concurrent or discharged patients.
  • Consult with Physician Advisors to assist with the determination of appropriate status and follow up regarding medical necessity for admission to and continued stay in the acute care setting.
Requirements
  • Associate's degree in nursing (graduate of an approved nursing program)
  • 5 years of experience in healthcare/medical acute care (acute hospital setting)
  • Valid North Carolina RN license without sanctions
Preferred Qualifications
  • Bachelor's degree in nursing (BSN)
  • Utilization Review or other applicable certification
  • 3-5 years of recent acute hospital experience with relevant experience and working knowledge in Utilization Review, including managed care/commercial payers and governmental regulatory requirements
About UNC Health Care

UNC Health Care is an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.



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