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Utilization Review Specialist - Emergency Department

Job ID: 949680
Location: ,
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: Jan 14, 2022

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Job Description

Vidant Health

About Vidant Health

Vidant Health is a regional health system serving 29 counties in eastern North Carolina. We are working every day to improve the health of the 1.4 million people we serve. Vidant Health is made up of 8 hospitals, physician practices, home health, hospice, wellness centers and other health care services. Vidant Medical Center is affiliated with the Brody School of Medicine at East Carolina University. As a major resource for health services and education, Vidant Health strives to support local medical communities and to work with providers throughout the region to deliver quality care. Our goal is to enhance services that are available locally and to eliminate barriers involving time, distance and lack of awareness that sometimes prevent patients from receiving the care they need.

Position Summary

The ED Utilization Review Coordinator provides essential functions to include screening patients for admission appropriateness, initial level of care placement, and collaboration with physicians to ensure documentation of clinical pertinence. This role would be collaborating resource to social services in coordination of community services facility placement thus preventing an unnecessary admission. This ED Utilization Review Coordinator serves as a clinical resource to staff members and providers.


Utilizes evidenced based guidelines (such as MCG or other agreed upon evidenced based guidelines) to promote quality care, decrease variation and mitigate waste. Verifies patients needs for acute level of care, collaborating with utilization management nurse to prevent potential denials.

Manages observation stay patients assertively and ensures timely testing and treatment.

Develops and coordinates transition plans for patients transitioned to home with home health, community care coordination program, Hospice or Palliative care, home infusion and routine sub-acute and skilled post-acute providers; completes all necessary documentation and necessary handovers. 

Participates in nursing unit and department clinical outcome projects as well as process improvement initiatives of care management.  Such as high-ED utilizer initiatives.

The care manager partners and collaborates with the physician, social workers, nurses as well as other members of the interdisciplinary team, regarding the patient's plan of care.  

The care coordinator shall support compliance with the regulatory landscape such as CC 44, IMM, ABNS, HINs, Moon, and Conditions of Participation for DC Planning and Utilization Review, and address opportunities or potential concerns with leadership.

Minimum Requirements

Bachelor's degree in nursing is preferred.

Current licensure as a registered nurse by the North Carolina Board of Nursing is required.

Adherence to the credentialing requirements of Vidant Health as stated in the nursing bylaws is required.

Care management certification and MCG certification recommended.

Three or more years of experience in a clinical setting, ambulatory or post-acute, care coordination experience is preferred.

Excellent clinical knowledge and skills, strong communication, interpersonal, emotional intelligence, organization and leadership skills. Must be PC literate with basic knowledge of Windows Microsoft Office, knowledge of Epic.

Preferred Requirements

Emergency Department experience preferred. 

Other Information

  • Full-time position 
  • On-site position
  • Schedule includes Saturdays, Sundays and two week days
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