What are the responsibilities and job description for the RN Utilization Review position at Carteret Health Care?
- JOB RELATIONSHIPS
- Position reports to the Director of Quality. Works closely with Case Management staff, physicians, Vice President of Medical Affairs, and the Business Office.
- DEFINITION OF POSITION
- 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.
- QUALIFICATIONS
- Professional
- 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.
- Registered nurse with current North Carolina license required.
- A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience.
Location: Carteret Health Care · Quality
Schedule: PRN (as needed), Days, 20