What are the responsibilities and job description for the RN Utilization Review position at Carteret Health Care?
JOB RELATIONSHIPS
Position reports to the Director of Quality. Works closely with Case Management staff, physicians, Vice President of Medical Affairs, and the Business Office.
DEFINITION OF POSITION
The Utilization Review RN will ensure regulatory compliance with CMS Conditions of Participation with regard to Utilization Management. Individuals will perform Utilization Review according to CMS guidelines, participate in denial/appeal process, and interact with physicians regarding Utilization Management concerns.
QUALIFICATIONS
Professional
Associates Degree in Nursing required; BSN preferred. 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.
Registered nurse with current North Carolina license required.
A certification in Case Management (i.e. CCM, ACM) can substitute for 1 year of experience.
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