Utilization Review Nurse
Kinston, NC
Remede Consulting Group
5x8 hrs, Days
Referral Bonus

Utilization Review Nurse
*THIS IS NOT A REMOTE POSITION. It is an in person role.
Shift:
5x8’s; M-F; 8:30 – 5pm
No Weekends
No Call
EDUCATION
Graduate from an accredited school of nursing, BSN preferred.
EXPERIENCE
Minimum of two (2) years of Utilization Review experience.
EPIC experience is required
Acute Hospital experience is required
Must have travel experience.
SKILLS:
Utilization Review experience required.
Experience in Denials Management – Insurance Denials, Peer-to-peer, Appeals is preferred.
Experience with completing Utilization Review in the hospital setting and using InterQual and MCG evaluation criteria to justify admissions and level of care with insurance companies
LICENSURE /CERTIFICATION
NC or compact state RN license
BLS Required
ACM/CCM Preferred
Average daily census : 30
Orientation: 24 hours
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.