Utilization Review Denials Nurse at UNC Health Care Kinston, NC

Utilization Review Denials Nurse – UNC Health Care (Kinston, NC)

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well‑being of the unique communities we serve.

Coordinates and leads all clinical denial processes and clinical audit activities. Collaborates with teammates involved in the denial process. Reviews all denial requests and leads the team in the strategy to appeal all clinical denials. Provides the clinical expertise to draft the first and second levels of an audit appeal. Works collaboratively with the Physician Advisors and subject matter experts for all audit and appeals work activities.

Assists with documentation review to support the clinical documentation specialists and Patient Financial Services. Supports the Utilization Review Nurse team when necessary by applying 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 clinical information to assure reimbursement; and coordinating care with the treatment team, patient, family, and others. Communicates with physicians for appropriate documentation to support authorization of services.

• Graduate from an accredited school of nursing, BSN preferred.

• Minimum 3‑5 years of applied clinical experience as a Registered Nurse required.
• 2 years utilization review, care management, or compliance experience preferred.
• Minimum 1 year clinical denials management preferred.

• Licensed to practice as a Registered Nurse in the state of North Carolina.

Qualified applicants will be considered without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, status as a protected veteran or political affiliation. Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.