Utilization Review Nurse

Position: Utilization Review Nurse

Location: 100% Remote

Duration: 8 Week Contract, with possibility of extension

Start Date: ASAP

Job Description:

The Utilization Review Author will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Author will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Author will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. The successful candidate must have hospital-based Utilization Review or Case Management experience.

Responsibilities:

· Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care

· Abstract data from a variety of medical records to ensure accurate clinical data

· Adhere to established quality, timeliness, and productivity outputs required in the completion of first level nursing utilization review

· Ensure effective communication internally and externally while delivering excellent customer service

· Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training and other opportunities that promote growth

· Complete and maintain annual compliance and annual HIPAA training

· Participate in organizational educational offerings and required training as needed to support service delivery

Minimum Qualifications:

· Must have a current Registered Nurse license

· At least 2 years of recent hospital-based Utilization or Case Management Experience

· At least 3 years of clinical nursing experience (practice)

· Knowledge of current Medicare rules and regulations related to Utilization Review

· Strong analytical, organizational and time management skills

· Ability to work independently with limited supervision

· Excellent written and verbal communication skills

· Excellent clinical abstraction and attention to detail

· Experience with InterQual and/or MCG is required

· Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays Coverage Hours: 7:00AM-1:00AM EST