RN Utilization Review

About the Role

This position monitors and evaluates patient care utilization, managing projects and processes within the utilization review group. The role provides expert counsel on optimal healthcare resource use, aligning with patient needs and regulatory compliance while working under minimal supervision.

Responsibilities

• Reviews patient needs and conditions to deliver nursing care within the assigned unit, ensuring every patient receives direct and proper care.
• Reviews patient records and develops strategies to optimize healthcare resource utilization.
• Prepares reports and examines trends to identify opportunities for efficiency and quality improvements.
• Applies knowledge of utilization review methodologies to serve as a resource for training and ensuring compliance with regulations.
• Seeks guidance from senior management as needed to clarify coverage and utilization criteria.
• Performs other duties as assigned.

Requirements

• Bachelor's of Nursing Degree.
• 2 years of cumulative experience as a practicing RN.
• Registered Nurse license in North Carolina or a Compact state.
• BLS (CPR) certification from American Red Cross or AHA Healthcare Provider.
• National certification in a clinical specialty area.