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Utilization Review Specialist - Part Time

Job ID: 954668
Facility: Vidant Health
Location: Greenville, NC
FT/PT: Part-Time
Reg/Temp: Regular
Date Posted: Nov 12, 2021

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

Responsibilities

Utilization Management. Utilizes the nursing process to assess, plan, implement and evaluate the utilization management needs for patients in assigned caseload. Performs utilization management activities using approved screening criteria.

Provides follow up with appropriate resource for utilization management issues/non-compliance.

Clinical Progression and Utilization Management.  Participates in quality improvement (QI) activities.

Advances knowledge and skills in case / utilization management.

Collaborates effectively with departmental staff to achieve goals and objectives.

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.

Other Information

Position is part-time

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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