Utilization Management RN Full-Time Remote Position
About The Position
HealthCare Strategies is hiring a full-time, remote Utilization Management RN to work from a home office. The schedule is Monday through Friday, 40 hours per week, from 9:00 a.m. to 6:00 p.m. Eastern Time. The RN collects personal and clinical information about participating plan members to provide patient education, make initial determinations of medical appropriateness for communication to the health benefit plan, and identify individuals who may benefit from Large Case Management. The role includes conducting telephonic clinical assessments, reviewing medical necessity, and communicating review outcomes to providers within appropriate time frames. HealthCare Strategies provides medical management services and technology platforms offering informatics-driven health management services and clinical programs.
Requirements
- Active, unrestricted RN license.
- At least 1 year of experience in a hospital setting.
- Minimum internet speeds of 25 Mbps download and 25 Mbps upload.
- Strong verbal communication skills.
- Problem-solving and decision-making skills.
- Ability to independently carry out detailed written or verbal instructions.
- Proficiency with Microsoft Office Suite, including Outlook and Word.
Nice To Haves
- At least 1 year of previous utilization management experience.
- Experience using InterQual criteria.
Responsibilities
- Conduct telephonic clinical assessments.
- Obtain relevant information from healthcare providers, patients, or family members about planned procedures, admissions, continued stays, and discharge plans.
- Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services.
- Identify and refer individuals who may benefit from Case Management.
- Document each call completely, accurately, and promptly in the computer system.
- Follow documented policies and procedures for handling confidential materials and patient-specific information.
- Answer direct telephone calls about medical services and determine whether prior authorization is required.
- Retrieve and acknowledge voicemail messages requesting medical services.
- Complete medical necessity reviews and communicate outcomes to providers within appropriate time frames.
- Provide educational materials and direct callers to community services when indicated.
- Provide coverage for professional colleagues.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
