Remote Utilization Management Nurse (RN)

Job Overview

  • Clinical License RN
  • State(s) Nationwide

Full job description

3+ Years Managed Care (Health Insurance Company) Experience is a MUST.

The Utilization Management nurses role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive hospital stays.

Job Duties and Responsibilities:

Utilization Management:

· Concurrent review of patient’s clinical information for medical necessity

· Pre-certification requests for medical necessity

· Coordinates patient’s discharge planning needs with the healthcare team

· Employ effective use of clinical knowledge, critical thinking, and evaluation skills

· Maintain accurate records in the designated medical management system

· Ability to stay organized and interact well with others

· Provide updates to Manager of Utilization Management

Skills and Qualifications:

· Multistate Compact State licensure as a Registered Nurse (RN)

· Minimum 3 years of prior experience in Health Insurance Company Utilization Management

· Extensive history of using InterQual Criteria

· Strong knowledge of word processing and working with care management platforms or spreadsheet computer programs

· Utilization Management certification preferred for UM nurses

Job Types: Full-time, Contract

Pay: From $45.00 per hour

Schedule:

  • 8 hour shift
  • Monday to Friday

Experience:

  • Managed Care (Health Insurance): 3 years (Required)

License/Certification:

  • Multistate Compact Nursing License (RN) (Preferred)

Work Location: Remote

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