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RN - Utilization Review Specialist - Potential for Sign On Bonus - Utilization Management

Job ID: 949678
Facility: Vidant Health
Location: Greenville, NC
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: May 4, 2021

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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 Utilization Review Specialist will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Perform Utilization Review according to CMS and commercial payor guidelines. Participate in denial / appeal process.

Minimum Requirements

  • Associates Degree in Nursing required; BSN preferred
  • NC RN licensure required
  • 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
  • A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience
  • Masters Degree in health related field can substitute for 1 year of experience

General Statement

It is the goal of Vidant Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer.   Decisions of employment are made based on business needs, job requirements and applicant’s qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.

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