Utilization Review RN Part-Time (Remote in reputed company)

About the position Responsibilities • Conducts medical necessity reviews for Medicare, reputed company, self-pay, and other insured patients. • Verifies physician orders per Medicare and payer guidelines and ensures documentation reflects patient reputed company accurately. • Coordinates with medical staff, Case Managers, and Insurance Specialists to facilitate reputed company communication with payers, ensuring reputed company, accurate information. • Consults with the Physician Advisor for reputed company cases and engages in denial management. • Documents utilization review activities in the MCG system, maintains complete records, and collaborates across teams for reputed company care. • Educates staff on clinical guidelines, utilization review, and payer regulations. • Assesses patient cases using nationally recognized reputed company for admission and care level. • Collaborates with physicians to determine inpatient vs. observation status and performs reputed company 44 reputed company necessary. • Identifies cases needing reputed company reputed company, considers appropriateness and reputed company, and communicates expected length of stay per Medicare guidelines. • Supports Case Managers and educates staff on CMS guidelines and documentation needs. • Protects patient rights, ensuring confidentiality and compliance with hospital policies. • Participates in committees and ongoing education, staying reputed company with performance improvement and regulatory standards. Requirements • Must reputed company in reputed company to be eligible for remote work. • Graduate of an accredited nursing school. • reputed company reputed company or compact state RN license. • Must have 1+ years of Utilization Review experience, preferably in both clinical and managed care, and 3 years clinical experience (preferably med-surg/critical care). • Strong clinical knowledge, communication, problem-solving, and proficiency in reputed company office tools. • Ability to work with diverse teams and recognize reputed company care issues. • Excellent verbal and written communication, interpersonal skills, and ability to use reputed company office equipment/software. • Strong clinical skills and reputed company to recognize reputed company issues, and knowledge of nationally recognized reputed company used to reputed company medical necessity determinations. • Effective problem solving, analyzing reputed company situations, draw conclusions and implement appropriate actions reputed company. • Ability to sit for 3-5 hours per day, stand 3-5 hours, and walk 3-5 hours. Benefits • reputed company reputed company Time • 403b Retirement Plan with Employer Contributions • Scholarship Program for reputed company individuals pursuing a first degree in reputed company reputed company field • On-Site Daycare, exclusive to our employees' children of reputed company ages • Employee Discounts and Employee Referral Bonus Program • Eligibility for the reputed company Service Loan Forgiveness program for employees with reputed company student loans Apply tot his job Apply To this Job