Part-Time, Temporary Concurrent Review Nurse - Remote

Overview

The Part-time, Temporary UM Concurrent Review Nurse is responsible for the medical necessity review of outpatient services that require prior authorization, and/or management of concurrent inpatient admissions.

In Short

• Responsible for performing inpatient and outpatient utilization reviews.
• Evaluates member needs at the time of inpatient admission.
• Triage and prioritize cases to meet CMS turnaround time standards.
• Prepare and escalate cases to MDs when appropriate.
• Establish relationships with providers to determine needed services.
• Maintain accurate records of utilization review activities.
• Adhere to quality standards and confidentiality policies.
• Ensure compliance with state and federal regulations.
• Drive the HealthAxis culture through customer service standards.
• Accountable for outstanding customer service to all contacts.

Requirements

• Licensed RN or LPN required.
• 2-3 years of varied clinical experience required.
• Managed care experience preferred.
• Ability to read and interpret documents and calculate figures.
• Excellent oral and written communication skills.
• Proficient in MS Office and basic computer skills.
• Excellent customer service skills.
• InterQual experience helpful.

Benefits

• Flexible part-time schedule.
• Opportunity to work remotely.
• Engaging company culture focused on people-first approach.
• Supportive team environment.