Utilization Review Author-Remote

R1 RCM•Remote, AL, AL

2d•$65,478 - $96,885•Remote

About The Position

R1 is a leading provider of technology-driven solutions for the healthcare industry, aiming to transform patient experience and financial performance. The Utilization Review Specialist will be part of the Physician Advisory Team, responsible for first-level initial admission and continued stay case reviews. This role involves determining appropriate cases for review using client-specific guidelines and ensuring that necessary orders and clinical documentation are in place before applying evidence-based criteria.

Requirements

Bachelor’s Degree
Current Registered Nurse license
2 years of recent hospital-based Utilization Review 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 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.
Hiring day shift: 8am-4pm and night shift 4pm-12am.
Must be able to work 4 weekend days a month.

Nice To Haves

2 years of recent hospital-based Utilization Review preferred
Experience with InterQual and/or MCG is preferred

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.