Job Description

ECU Health

About ECU Health Medical Center

ECU Health Medical Center, one of four academic medical centers in North Carolina, is the 974-bed flagship hospital for ECU Health and serves as the primary teaching hospital for The Brody School of Medicine at East Carolina University. ECU Health Medical Center has achieved Magnet® designation twice and provides acute and intermediate care, rehabilitation and outpatient health services to a 29-county region that is home to more than 1.4 million people.

Position Summary

The Utilization Review Quality Specialist will support Utilization Review services in auditing clinical criteria of nurse reviews to ensure correct level of care, staff competency, regulatory requirement adherence, and quality reviews. This role will identify educational needs and provide specialized education to the UR team members, and other disciplines across the healthcare system that support and/or collaborate with UR functions.

Responsibilities

• Monitors/Audits UM nurses criteria reviews to ensure referral integrity is maintained and to ensure adherence to MCG or other evidenced based guidelines.
• Conducts timely and consistent coaching/monitoring with a goal of instilling and maintaining confidence and empowerment while identifying areas in need of improvement
• Analyzes and communicates with UM Management team regarding patterns and trends in performance and maintains systems for ensuring follow-up. Identifies resources and techniques that would assist in quality improvement.
• Defines individual and team needs to improve and recognize competencies and to relay non-restrictive flow of information.
• Provides ongoing training/education utilizing modules, case studies and other methods deemed appropriate to enhance the teams understanding of evidenced base guidelines, primarily through MCG, and improve the quality of criteria reviews completed.
• Administers routine competency testing and oversees annual UR competencies.

Minimum Requirements

• Bachelor's degree in Nursing (BSN) or higher
• 5 Years of Nursing experience with minimum 2 Years of UR Experience
• MCG Guideline Experience - minimum 1 year
• NC RN licensure required

General Statement

It is the goal of ECU Health and its entities to employ the most qualified individual who best matches the requirements for the vacant position.

Offers of employment are subject to successful completion of all pre-employment screenings, which may include an occupational health screening, criminal record check, education, reference, and licensure verification.

We value diversity and are proud to be an equal opportunity employer. Decisions of employment are made based on business needs, job requirements and applicant's qualifications without regard to race, color, religion, gender, national origin, disability status, protected veteran status, genetic information and testing, family and medical leave, sexual orientation, gender identity or expression or any other status protected by law. We prohibit retaliation against individuals who bring forth any complaint, orally or in writing, to the employer, or against any individuals who assist or participate in the investigation of any complaint.