Utilization Review Nurse (Rn)

Clinical Utilization Review Nurse (RN)

Full-time | Remote | Permanent

Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources!

Purpose:

Our Clinical Utilization Review services consists of supporting the Utilization Review component of the case management process. Our team members review medical record documentation and apply clinical criteria and guidelines to ensure the appropriate clinical level of care and adherence to related regulatory and payer guidelines. Our goal is to support clients in achieving access to care for patients and appropriate utilization of resources.

Reports to:

Manager of Clinical Appeals

Accountabilities:

· Adhere to the client’s Utilization Review plan, policies, and procedures and monitor the appropriateness of hospital admissions and extended hospital stays.

· Ensure workload is completed in an efficient and timely manner.

Essential Job Functions:

Complete the following functions in accordance with Managed Resources policies:

·Establish an efficient method of ensuring the medical necessity and appropriateness of hospital admissions.

· Perform concurrent reviews to ensure the continued stay is medically justified based on the medical record documentation.

·Refer cases to the Utilization Review physician advisor as appropriate that do not meet medical necessity guidelines for admission or continued hospital stay.

·Coordinates with Utilization Review department to ensure submission of necessary documentation to payers.

Ideal candidate will possess the following:

· RN licensure is Required.

· Certification in Case Management and/or CPUR, CUMC (preferred)

· Three (3) or more years of hospital setting Utilization Review experience is Required.

· Five years of acute hospital experience is Required.

· Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards.

· Excellent verbal and written communication skills.

· Excellent organization and attention to detail.

· Ability to manage time and meet deadlines.

Working Environment:

Normal remote home business office conditions.

Check Out Our Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Disability insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Vision insurance
• Pet Insurance
• Monthly Internet Stipend

Our Vision:To become the most trusted, innovative and consultative revenue cycle partner in the nation.

Pay: $38.00-$42.00 per hour

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Managed Resources is an Equal Opportunity Employer (EOE) M/F/D/V/SO

Job Type: Full-time

Schedule:

• Day shift
• Monday to Friday

Work Location: Remote