RN Utilization Review

A Registered Nurse (RN) 3 Utilization Review monitors and evaluates patient care utilization. Working under minimal supervision, this role manages projects and processes within the utilization review group and provides expert counsel to the organization on the optimal use of healthcare resources in alignment with patient needs and regulatory compliance.

Essential Job Functions:

• Reviews patient needs and conditions to deliver nursing care within the assigned unit to ensure that every patient receives the direct and proper care needed.

• 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.

Education:

• Required: Bachelor's of Nursing Degree.

Experience:

• Required: 2 years of cumulative experience as practicing RN.

Licensure/Certification/Listing:

• Required: Registered Nurse license in North Carolina or a Compact state.

• BLS (CPR)-American Red Cross or AHA Healthcare Provider.

• National certification in clinical specialty area.