Remote Utilization Review Nurse

The Csi Companies Inc. Of Florida • Minnetonka, MN

302d • $35 - $42 • Remote

About The Position

The Remote Utilization Review Nurse is primarily responsible for conducting retrospective medical necessity reviews for inpatient and outpatient services, ensuring compliance with established medical criteria and supporting reimbursement processes. This job can be worked from anywhere in the US as long as you have high speed internet and a distraction-free home office area.

Requirements

• High school diploma or equivalent
• Active, unrestricted RN or LVN license in state of residency
• Completion of an accredited Registered Nurse or Licensed Vocational Nurse program
• Minimum 3 years of clinical practice experience
• Minimum 2 years of utilization management and/or case management experience
• A reliable high-speed internet connection (the faster the better!)
• Ability to pass a background check and drug test
• Private, quiet, and distraction-free workspace in a room with a closed-door

Nice To Haves

• Large corporation experience
• Health plan / managed care / healthcare industry experience
• Bachelor's degree in Nursing or a related healthcare field

Responsibilities

• Conduct retrospective clinical reviews based on state and medical necessity criteria using InterQual guidelines
• Apply critical thinking and adhere to documented processes to support clinical appellate reviews
• Meet department standards for productivity and quality, ensuring timely review of assigned cases per payor guidelines
• Perform follow-up on initial denials received from payors on retrospective clinical reviews by first level of appeal submission
• Validate that Diagnosis and Procedure codes align with services performed, escalating discrepancies as needed
• Maintain compliance with HIPAA regulations and ensure confidentiality of medical records

Benefits

• Weekly pay
• Medical, dental, and vision coverage
• Voluntary Life and AD&D coverage
• Paid Training
• Opportunity for advancement upon performance and availability

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: Bachelor's degree