Utilization Review Registered Nurse (RN) - Remote

Overview

The Utilization Review Registered Nurse (RN) specializes in examining medical records and developing clinical reviews to support authorization obtainment, avoid payment denial, and optimize reimbursement.

In Short

• Conducts initial and concurrent Utilization Reviews for patients.
• Requires a current unencumbered RN license in state of residency.
• Minimum of three years of healthcare clinical experience is required.
• Advocates for patients with insurance companies.
• Collaborates with interdisciplinary teams for patient care.
• Maintains knowledge of payor requirements and federal regulations.
• Participates in process improvement initiatives.
• Communicates effectively with various stakeholders.
• Provides training and orientation for staff.
• Manages a diverse workload in a fast-paced environment.

Requirements

• Current RN license in West Virginia or eNLC.
• Bachelor's or Associate Degree in Nursing preferred.
• Experience in Medical Management for Medicare/Medicaid populations.
• Utilization Management experience preferred.
• Effective verbal and written communication skills.
• Strong attention to detail and interpersonal skills.
• Knowledge of medical terminology and third-party payers.
• Ability to use tact and diplomacy.
• Proficient in computer usage.
• Excellent customer service skills.

Benefits

• Opportunity to work in a reputable health system.
• Engagement in process improvement initiatives.
• Collaboration with interdisciplinary teams.
• Professional development opportunities.
• Flexible working environment.