Utilization Management RN Remote

About the Role

Monitor admissions and perform initial and continued stay medical necessity reviews. Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement. Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials. Build relationships to promote interdisciplinary collaboration. Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.

Schedule

• Full time
• Day shift (United States of America)
• 4/10hr shifts (630am - 5pm / 7am - 530pm) with a weekend rotation

Knowledge, Skills, and Abilities

• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
• Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
• Ability to understand differences between notification, reference, and authorization numbers.
• Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
• Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.

Education

• Associate's of Nursing [Required]
• Bachelor's of Nursing [Preferred]

Work Experience

• 3+ years clinical nursing [Required]
• 5+ years clinical nursing in an acute care setting [Preferred]
• Experience working in electronic health records [Preferred]
• Utilization Management or Case Management [Preferred]

Licenses and Certifications

• Registered Nurse (RN) [Required]
• Accredited Case Manager (ACM) [Preferred]
• Certified Case Manager (CCM) [Preferred]

Pay

$68,132.50 - $119,520.35