RN Utilization Management Care Reviewer - Remote

Overview

The RN Utilization Management Care Reviewer will evaluate patient care and conduct reviews to ensure exceptional services are delivered, collaborating with case managers and medical directors.

In Short

• Fully remote position with a Monday - Friday schedule.
• Evaluate patient care and conduct service reviews.
• Collaborate with multidisciplinary teams.
• Determine medical appropriateness of requested services.
• Manage length of stay and discharge planning.
• Adhere to UM policies and procedures.
• Must have an active RN license and five years of clinical experience.
• Proficient in medical record review and computer usage.
• MCG certification preferred.
• Comprehensive benefits package offered.

Requirements

• Bachelor’s degree in nursing or equivalent knowledge.
• Active, unrestricted State Registered Nursing (RN) license.
• Five years of clinical nursing experience.
• Proficiency with Microsoft Suite and EMR systems.
• MCG certification or ability to obtain within six months.
• Two to three years of Utilization Management experience preferred.
• Case Management Certification preferred.
• Experience with Medicare Advantage and ACOs is a plus.
• Knowledge of URAC and NCQA accreditation processes preferred.
• Additional related education or experience preferred.

Benefits

• Better pay and benefits for nurses.
• Health and financial security options.
• Comprehensive benefit package for eligible positions.
• Opportunities for professional growth.
• Supportive work environment focused on community health.