Utilization Review Nurse
Kinston, North Carolina
UNC Lenoir Health Care

Job Opportunity: Utilization Review Nurse

Location: Kinston, North Carolina
Employment Type: Travel/Contract
Contract Length: 13 weeks

Position Details

• In-person role (not remote)
• Shift: Monday to Friday, 8:30 AM – 5:00 PM (5 days x 8 hours)
• No weekends, no on-call duties
• Average daily census: 30 patients
• Orientation: 24 hours

Job Description

• Facilitate utilization management to ensure appropriate care at the right place and time
• Apply established criteria to evaluate admission appropriateness, level of care, continued hospitalization, and readiness for care transition
• Conduct concurrent reviews and proactively resolve care, service, or transition delays/issues
• Provide clinical information to third-party payers to support reimbursement
• Collaborate and communicate with physicians, care teams, patients, and families to support authorization of services
• Use InterQual and MCG evaluation criteria for utilization review justification

Required Qualifications

• Valid Registered Nurse (RN) license in North Carolina
• Minimum 2 years of Case Management experience, including experience within the last year
• Completion of at least one prior travel assignment
• Basic Life Support (BLS) certification issued by the American Heart Association or American Red Cross
• Associate of Science in Nursing (ASN) or Associate Degree in Nursing (ADN)
• Experience in an Acute Care setting
• Utilization Review experience, including use of InterQual criteria
• Knowledge of insurance processes related to utilization review
• Experience with Epic electronic health record system

Preferred Qualifications

• ACM (Accredited Case Manager) or CCM (Certified Case Manager) certification preferred
• Experience in Denials Management including insurance denials, peer-to-peer reviews, and appeals preferred

Required Skills

• Utilization Review in hospital setting
• Knowledge of insurance denials and appeals processes
• Ability to use InterQual and MCG criteria for utilization review

Compliance and Documentation Requirements

• Background check: 7-year criminal history, education verification, and other standard screenings
• Drug screening: Negative 10-panel drug screen within 90 days of start (instant screens allowed as placeholder if pending)
• Physical exam within 1 year of start
• Immunizations and health documents required:

  • Tdap vaccine within 10 years (titer not accepted)
  • Negative TB test or chest X-ray within 1 year (or proof of past positive with required follow-up)
  • 2 MMR vaccines or positive titers for measles, mumps, and rubella
  • Hepatitis B vaccine series and/or titer, or declination documentation
  • Varicella immunity documentation (vaccines, titer, or physician-documented history)
  • Seasonal flu vaccine required during flu season (medical or religious exemptions accepted with approval)
  • COVID-19 vaccination proof if vaccinated (requirement may be waived if unvaccinated)
• Certifications must be current and valid at start date (no certifications expiring within 30 days of start accepted without renewal proof)

Additional Notes

• Candidates must complete required LMS modules during orientation
• Facility-specific confidentiality and code of conduct forms may be required to review and sign
• Medication/pharmacology competency exam required as applicable for care managers/case managers

This role is ideal for experienced Utilization Review Registered Nurses with acute hospital and EPIC experience who have prior travel contract experience and are seeking a weekday, day-shift position without weekends or call.