Utilization Review RN

What We Offer:

Why This Role Matters

The Utilization Review RN plays a critical role in ensuring the integrity and compliance of patient health records, while supporting patient care by driving accuracy and adherence to ensure accurate and compliant billing.

What You’ll Do:

• Schedule - Monday - Friday, daytime hours, weekend, and holiday rotations are required.
• Conduct thorough chart reviews, within the assigned facilities, to ensure Medicare rules are adhered to for compliance and reimbursement.
• Provide administrative and technical support to the Utilization Review team to ensure timely payer communication, authorization tracking, and accurate documentation.
• Process large volumes of confidential patient and payer information to support billing workflows (includes managing payor communications and processing authorizations).
• Collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance.
• Participate in quality improvement initiatives within the department.
• Maintain compliance and regulatory standards and organizational policies. All Utilization Review activities are performed in accordance with the current policies and procedures, mission, vision, and values of Novant Health.
• Establish and maintain effective work relationships with both internal and external customers.

What You’ll Need:

Required:

• Current RN licensure in the appropriate state.
• Graduate of an accredited school of nursing.

Preferred:

• Bachelor’s degree in Nursing.
• 2+ years of healthcare experience including utilization review or related experience.

What’s In It for You:

• Comprehensive benefits include health, dental, vision, and life insurance.
• Retirement fund with matching contributions.
• Tuition assistance for qualifying team members.