Job Description
Quality Staffing Specialists are currently seeking skilled Registered Nurses to work within the hospital in Case Management/Utilization Review. This position facilitates utilization management processes to ensure the right care is provided at the right place at the right time. To accomplish these goals, the UR Nurse applies established criteria to evaluate the appropriateness of admission, level of care, continued hospitalization, and readiness for care transition; assures timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as necessary, in collaboration with the care team. This position provides third-party payers with clinical information to assure reimbursement, and coordinates care with the treatment team, patient, family, and others. Communicates with physicians for appropriate documentation to support authorization of services. Average daily Census: 20. Required Skills/Experience: Must have 2 years of recent Acute Hospital experience in Case Management/Utilization Review. Must have experience in MCG (Milliman Care Guidelines) and InterQual. Work Setting: Acute Care Hospital Case Management/Utilization Review Skills: Admission Criteria, Concurrent Review, Continued Stay reviews, Determine medical necessity per Evidence-Based Guidelines, Prior Authorization, Utilize InterQual Criteria, and Utilize Milliman Guidelines. Must have previous travel/contract experience EMR: Epic experience required Location: Kinston, NC **You must reside >50 from the facility to qualify Rate: $2,480/weekly Shifts Available: Days: 8:30am-5:00pm (Monday-Friday), 5x8 hour shifts Scheduling Requirements: Length of contract: 13 weeks Hours per week: 40 No Weekends No Call Credential Requirements: Resume reflecting all experience & explanation of gaps in employment BLS Certification (AHA only) RN License in North Carolina or a Compact Licensure required Preferred Licen
