RN Utilization Review at Carteret Health Care – Morehead City, North Carolina
Carteret Health Care
Morehead City, North Carolina, 28557, United States
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About This Position
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JOB RELATIONSHIPS
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Position reports to the Director of Quality. Works closely with Case Management staff, physicians, Vice President of Medical Affairs, and the Business Office.
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DEFINITION OF POSITION
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The Utilization Review RN will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Individuals will perform Utilization Review according to CMS guidelines, participate in denial/appeal process, and interact with physicians regarding Utilization Management concerns.
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QUALIFICATIONS
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Professional
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Associates Degree in Nursing required; BSN preferred. If ADN prepared must have 5 + years’ experience in an acute care hospital; home health agency; commercial insurance company; case management. If BSN prepared, must have 3-5 years’ experience in an acute care hospital; home health agency; commercial insurance company; case management.
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Registered nurse with current North Carolina license required.
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A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience.
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Job Location
Morehead City, North Carolina, 28557, United States
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