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 Overview

• 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

This position supports utilization management processes to ensure appropriate care delivery. Responsibilities include evaluating admission appropriateness, level of care, continued hospitalization, and readiness for care transition using established criteria. The nurse conducts concurrent reviews, resolves care or transition delays, collaborates with the care team, and communicates with physicians to support service authorization and reimbursement.

Required Qualifications

• Valid RN license in North Carolina
• Associate of Science in Nursing / Associate Degree in Nursing
• Minimum 1 year of Case Management experience, including experience within the last year
• Experience in Utilization Review, including InterQual criteria
• Experience in Denials Management (Insurance Denials, Peer-to-peer, Appeals)
• Experience with Insurance processes
• Experience in an Acute Care setting
• One completed travel assignment
• Experience with Epic electronic health record system
• BLS certification issued by American Heart Association or American Red Cross

Compliance & Documentation Requirements

Background Checks

• 7-year criminal background check within 90 days of start, updated annually
• EPLS/GSA/SAM and HHS/OIG checks required within 30 days of start and updated every 30 days during assignment

Education & Verification

• Education verification must be completed within 90 days of start
• Diploma or transcript required

Health & Immunizations

• Physical exam within 1 year of start
• Negative TB test or chest X-ray within 1 year (or proof of past positive with required follow-up)
• Tdap vaccine within 10 years (titer not accepted)
• 2 MMR vaccines or positive titers for measles, mumps, rubella
• Hepatitis B vaccine series and positive titer, or declination
• Varicella immunity by vaccine, titer, or documented history
• Seasonal flu vaccine required during flu season (medical or religious exemptions accepted with approval)
• COVID vaccination proof if vaccinated (requirement may be waived if unvaccinated)
• Negative 10-panel drug screen within 90 days of start (instant drug screens not accepted unless pending standard results)

Certifications (as applicable)

• ACLS, PALS, NRP, NIH Stroke Certification, CPI, and others depending on unit assignment (BLS required for all units)

Additional Information

• Candidates must complete LMS modules during orientation
• Medication/pharmacology competency exam required as applicable
• Unit competency exams required
• Confidentiality and Code of Conduct attestations required (except for this facility)

This role is ideal for experienced Utilization Review nurses with acute hospital and travel experience, seeking a structured weekday schedule without weekends or call.