Utilization Review (UR) Author - RN Required

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. 

As our Utilization Review Author (UR Author) - RN Required, you 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. After identifying a case, the Utilization Review Author will ensure appropriate orders and clinical documentation are in place before applying the evidence-based criteria.  The successful candidate will have hospital-based Utilization Review or Case Management experience.

**Flexible Schedule with some weekend requirements throughout the month*

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

Required Qualifications:

• Must have a current Registered Nurse license in your state of residence

• Bachelor’s Degree

• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred

• 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 preferred

• Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays (Coverage Hours: 7:00 AM-12:00 AM EST)