Utilization Review Coordinator jobs in North Carolina

• Provides ongoing clinical review of patients served at the facility – from admission through discharge (in conjunction with the Utilization Review Committee, the Quality Assurance Coordinator, Director of Nursing, Clinical Program Director, CMO/Clinical Director, and CEO/Facility Director).   
• Leads team in assuring that admissions, continued stays, discharges, and appeals related to service provisions are reviewed and responded to in a timely and clinically sound manner in accordance with written policies of the governing body and the facility’s Utilization Management Plan.  
• Follows policies and protocols defined by third party payers for patients entitled to benefits under the Medicare and Medicaid programs; and handles clinical consultations with insurance carriers, managed care entities, and Quality Improvement Organizations for certification and re-certification of services.  
• Familiar with all aspects of beneficiary rights, quality improvement efforts, and payment and reimbursement issues.  
• Facilitates educational and training activities with clinical staff related to quality improvement efforts, risk management and areas related to patient safety and staff responsiveness.

Candidates are qualified based upon the information submitted on the state job online application.  Any information omitted from the application but included in an attachment, will not be considered as qualifying experience.  PLEASE INCLUDE ALL Knowledge, Skills and Abilities IN THE BODY OF THE APPLICANTION, resumes are not acceptable. 

Work history and education (as applicable for the position) must be included on the application.  “See Resume or See Attachment” will not be accepted, nor is a text or attached resume accepted in lieu of a completed application.  Please complete your application in full.

Qualified applicants must document on the application that they possess ALL of the following:

• Considerable knowledge and skill in application of professional nursing theory, techniques and practices.
•  Demonstrated knowledge of beneficiary requirements for commercial coverage and of Medicaid and Medicare standards.
• Demonstrated ability to gather, compile, and analyze data related to quality patient care.
• Ability to approach job functions with opportunities to assist patients and improve delivery systems.
• Ability to communicate with all levels of staff and third party payors.

• Licensed to practice as a Registered Nurse in the State of North Carolina and 
• One year of experience in Utilization Review.

•  A strong nursing educational background is preferred with a focus and understanding of the particular needs of patients with co-occurring substance use and mental health disorders.
   

1. the employee has held a position in North Carolina State government, including the judicial system, or the University of North Carolina system within the last 12 months (the employee shall remain ineligible for 12 months from the separation date);
2. the employee has previously received a sign-on bonus from any State agency;
3. or DHHS has paid any contract placement or recruitment fees.

• All Division of State Operated Healthcare Facilities are a tobacco free environment.  The use of tobacco products of any kind including vapor products are prohibited from our campus.
• All employees are required to adhere to the facility’s Vaccination Policy.
• All positions in the Division of State Operated Healthcare Facilities shall be subject to pre-employment drug testing and criminal record background checks.