Utilization Review Nurse

ServusCare (a subsidiary of Veritas Allies) is a comprehensive medical management company that provides Virtual Nurse Triage, Utilization Review, Case Management, and Disease Management services. We work closely with members, providers, third-party administrators, stop-loss carriers, and involved healthcare partners to seamlessly manage complex cases.

RESPONSIBILITIES OF OUR UM/MN RN:

· Concurrent review of patient’s clinical information for efficiency

· Ongoing review of pre-certification requests for medical necessity

· Coordinates patient’s discharge planning needs with the health care team

· Employ effective use of knowledge, critical thinking, and skills to:

· Advocate quality care and enhanced quality of life

· Prevent patient complications during hospital stay

· Advocate decreased hospital stay when appropriate

· Maintain accurate records of all patient related interactions

· Work in an intensive, fast-paced environment with minimal supervision

· Ability to stay organized and interact well with others in any situation

· Ability to work effectively within multiple computer programs / platforms

· Ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members / families

QUALIFICATIONS:

· Current unencumbered RN license

· Compact license

· 5+ years clinical experience

· UR experience

· Proficiency using InterQual criteria and/or Milliman Care Guidelines (MCG)

· Strong assessment skills

· Customer service focused

· Experience with TPA / self-funded benefit plans

· Strong critical thinking skills

· Independent, Self-starter

· Ability to work remotely, including adequate high-speed home internet service

BENEFITS PACKAGE:

· Remote position

· Competitive pay

· Paid time off (PTO), including paid holidays

· Health insurance coverage options for you and dependents

· 401(k) Retirement Program

· License reimbursement

· Comprehensive training and development

WHY CHOOSE SERVUSCARE?

This is an amazing opportunity to join our progressive organization in the early stages of a meteoric growth trajectory. The Remote Utilization Management RN position affords the ability to help lead and shape the culture of our organization while also being mentored by industry experts. Our clinical leadership team has decades of combined diverse medical management experience and are incredibly well regarded in the industry. ServusCare has built a reputation as a comprehensive medical management solution that balances clinical excellence with a human touch to achieve cost savings without sacrificing compassion or the quality of patient care.

Job Type: Full-time

Benefits:

Health insurance

Paid time off

Referral program

Schedule:

8 hour shift

Day shift

Monday to Friday

Application Question(s):

Proficiency using InterQual Criteria and Milliman Care Guidelines (MCG)

Experience:

clinical: 5 years (Preferred)

UR, CM and/or DM: 5 years (Preferred)

License/Certification:

unencumbered RN license - prefer compact license (Required)

Work Location: Remote

Job Type: Full-time

Benefits:

• 401(k)
• Health insurance

Schedule:

• 8 hour shift
• Day shift
• Monday to Friday

Experience:

• Utilization review: 1 year (Required)

License/Certification:

• RN (Required)

Work Location: Remote