To support effective patient management, the full-time Registered Nurse Utilization Review will conduct initial and concurrent reviews of medical records to ensure authorization, optimize reimbursement, and prevent payment denials while working remotely. Key responsibilities Reviews and evaluates clinical information to support Utilization Management decisions based on medical record documentation Facilitates communication with payors regarding medical necessity and manages the authorization process in a patient-centered manner Collaborates with interdisciplinary teams to prevent and manage concurrent denials and advocates for patients with insurance companies Required qualifications Current Registered Nurse license issued by the state or a multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC) Three years of healthcare clinical experience Bachelor's Degree in Nursing, Associate of Science in Nursing, or currently enrolled in a BSN program with completion within three years of hire Experience in medical management for Medicare and/or Medicaid populations Utilization Management experience
Registered Nurse Utilization Review in workfromhome at Unknown Company
- Typical pay
- $71,760–$109,200
For context, most registered nurses earn between $71,760–$109,200 a year according to Bureau of Labor Statistics wage data. What this particular role pays is set by the employer — check the description above.
This position is listed as full time and able to be worked remotely.