Utilization Review Nurse Jobs Fully Remote Work

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:

• Licensed Registered Nurse obtained prior to hire date or job transfer date required.

• Diploma from an accredited school/college of nursing required