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Utilization Review Nurse

Remote:

Full Remote

Contract:

Fixed term

Experience:

Mid-level (2-5 years)

Work from:

China

Offer summary

Qualifications:

Registered Nurse (RN) with unrestricted MA license, BSN preferred, 3 years of clinical nursing experience, 3 years of utilization management experience.

Key responsabilities:

Perform utilization management activities
Collaborate with providers for transitions of care

US Tech Solutions Large http://www.ustechsolutions.com

1001 - 5000 Employees

See more US Tech Solutions offers

Job description

Job Title: Utilization Review Nurse
Location: Remote
Duration: 4 months contract
*Note: This position is 100% remote but required unrestricted MA license*
Overview:
We are seeking an experienced Utilization Review Nurse to provide clinically appropriate and cost-effective utilization management and discharge planning for members across multiple inpatient settings, including acute care, subacute care, and long-term acute care. The role involves determining medical necessity and benefit coverage for various lines of business, including Medicare and public plans, while ensuring members transition effectively through their continuum of care.
Key Responsibilities:

Perform utilization management activities, applying criteria such as InterQual, MCG, and proprietary medical necessity guidelines.
Collaborate with providers to facilitate timely transitions of care.
Manage multiple service reimbursement models, including DRG, case rate, and per diem.
Maintain accurate documentation in alignment with departmental standards.
Use clinical judgment to identify and escalate issues appropriately.
Provide mentorship and participate in special projects as assigned.

Qualifications:

Education: Registered Nurse (RN) with a current, unrestricted MA license; BSN preferred.
Experience:
- Minimum 3 years of clinical nursing experience.
- Minimum 3 years of utilization management experience, preferably in inpatient or managed care settings.
Skills:
- Strong communication, negotiation, and interpersonal skills.
- Proficiency with Microsoft Office Suite and the ability to adapt to new technologies.
- Strong time management and organizational skills.
- Ability to work independently in a fast-paced environment.

Working Conditions:

Remote role requiring excellent self-management.
Occasional overtime or flexible working hours may be needed.

About US Tech Solutions:
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.
"US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran."