Utilization Management RN Part-Time Remote Position

HealthCare Strategies, Inc.• US,

21h•$34 - $38•Remote

About The Position

HealthCare Strategies is hiring a part-time, remote Utilization Management RN working Monday through Friday, 20 to 25 hours per week. Core office hours are 9 a.m. to 6 p.m. Eastern Time. The role collects personal and clinical information about participating health 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 nurse conducts telephonic clinical assessments, gathers information about planned procedures, admissions, continued stays, and discharge plans, and applies nationally recognized criteria to support recommendations for inpatient and outpatient services. The role also handles medical-service calls and authorization requests, completes and communicates medical necessity reviews within required time frames, documents interactions in a computer system, follows confidentiality procedures, and provides educational resources and colleague coverage.

Requirements

Active, unrestricted RN Compact 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 information from health care providers, patients, or family members regarding planned procedures, admissions, continued stays, or discharge plans.
Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services.
Identify and refer individuals whose health or expenses 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 patient education, educational materials, and referrals to community services when indicated.
Provide coverage for professional colleagues.
Collect personal and clinical information to support initial medical-appropriateness determinations and identify members who may benefit from Large Case Management.