Utilization Review RN

Why This Role Matters

As the Utilization Review RN, you will play 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.

• Schedule - Monday - Friday, daytime hours, weekend, and holiday rotations are required.
• Provide administrative and technical support to the Utilization Review team to ensure timely payer communication, authorization tracking, and accurate documentation.
• Manage daily operations of the onsite Utilization Review (UR) offices, including processing mail, answering phone inquiries, making calls to verify authorizations and denial determinations, and faxing communications for multiple facilities.
• Process denials within a strict timeframe and manage payor work queues to avoid adverse determinations.
• Process large volumes of confidential patient and payer information to support billing workflows (includes managing payor communications, processing authorizations, addressing denials, and indexing faxes).
• Conduct thorough chart reviews, within the assigned facilities, to ensure Medicare rules are adhered to for compliance and reimbursement.
• 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.
• 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.
• Maintain compliance and regulatory standards and organizational policies.

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

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

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

At Novant Health, we believe remarkable care starts with compassion for our patients, our communities, and each other. We value belonging, courage, personal growth, and teamwork, creating a space where everyone is respected, supported, and safe to show up as their full selves.

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