Utilization Review Nurse Jobs Fully Remote Work

Job Responsibilities : Utilization Review RN – Part Time Weekends – Remote

Salary : $75000 per year

Company : Ascension

Location : Remote US

Additional Job Details:
Part-Time, 24 Hours

  • Saturday and Sunday, 7a-7p
  • Weekends only

Additional Information:Training: 6 weeks total
First 3 weeks need availability to train during the week
Last 3 weeks, will be training on the weekends

What You Will Do:

  • Review admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria.
  • Provide case management and/or consultation for complex cases.
  • Assist departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
  • Assess and coordinate discharge planning needs with healthcare team members.
  • May prepare statistical analysis and utilization review reports as necessary.
  • Oversee and coordinate compliance to federally mandated and third party payer utilization management rules and regulations.

What You Will Need:

Licensure / Certification / Registration:
  • Licensed Registered Nurse obtained prior to hire date or job transfer date required.
  • Diploma from an accredited school/college of nursing required

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