Part-Time, Temporary Utilization Management 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 prospective, concurrent, and retrospective inpatient and/or outpatient utilization reviews.
• Evaluates severity of illness and intensity of service for members at the time of admission.
• Triage and prioritize cases to meet CMS turnaround time standards.
• Prepare and escalate cases to MDs for review when appropriate.
• Demonstrates effective communication methods and skills.
• Establishes relationships with providers to determine needed services.
• Maintains accurate records of UR activities.
• Adheres to quality standards and confidentiality policies.
• Ensures compliance with state and federal regulations.
• Adapts to changes in policies and procedures.

Requirements

• Licensed RN or LPN required.
• Minimum of two to three years 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 with basic computer skills.
• Excellent customer service skills.
• InterQual experience helpful.

Benefits

• Flexible work schedule.
• Opportunity to work in a people-first environment.
• Engagement with a supportive team culture.