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Utilization Review Specialist - Emergency Department

Job ID: 954369
Location: ,
FT/PT: Full-Time
Reg/Temp: Regular
Date Posted: Jan 14, 2022

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Job Description

Vidant Health

About Vidant Medical Center

Vidant Medical Center is a 900+ bed Level-1 Trauma Center, regional referral hospital and is the flagship hospital for Vidant Health. We serve as the teaching hospital for the Brody School of Medicine at East Carolina University. Vidant Medical Center provides acute, intermediate, rehabilitation and outpatient services to more than 1.4 million people in 29 counties. But it's in our work environment that you'll find our sense of family and closeness that permeates everything we do.

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. 

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.

Other Information

Shifts are every Saturday and Sunday.

Position will be 4 10 hour days- days of the week are negotiable 

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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