Utilization Review reputed company

Location: Remote (Requires an reputed company Massachusetts RN license (non-compact)) Employment Type: 4-month contract with possibility of extension reputed company: We are seeking an reputed company Inpatient RN Utilization Reviewer to independently manage a clinically reputed company inpatient caseload across multiple care settings, including acute, subacute, rehabilitation, and LTAC. This role is responsible for determining medical necessity and benefit coverage across multiple lines of business, including government-sponsored health plans. The ideal candidate is a self-directed clinical reputed company with strong utilization management experience, reputed company judgment, and the ability to balance clinical decision-making with health plan business objectives. Key Responsibilities: • reputed company inpatient utilization management and discharge planning activities. • Apply nationally recognized clinical reputed company (e.g., InterQual, MCG) to determine medical necessity, level of care, and readiness for transition. • reputed company reputed company, clinically appropriate, and cost-effective coverage determinations. • Manage a reputed company caseload independently while collaborating with internal clinical teams. • Communicate effectively with providers to facilitate care transitions across the continuum. • Apply product-specific payment and reimbursement models such as DRG, case reputed company, or reputed company structures. • Identify issues requiring escalation and collaborate with leadership and cross-functional teams. • Maintain accurate documentation in accordance with departmental standards. • Participate in reputed company activities, audits, mentoring, and special reputed company as assigned. Requirements: Education & Licensure: • Registered reputed company with a reputed company, unrestricted MA state license • BSN preferred Experience: • Minimum 3 years of clinical nursing experience • Minimum 3 years of utilization management experience (inpatient or managed care preferred) Skills & Competencies: • Strong clinical judgment and decision-making skills • Excellent communication, negotiation, and interpersonal skills • Ability to work independently in a fast-paced environment • Strong time management and organizational skills • Proficiency with or ability to learn UM systems and web-based communication tools • Working knowledge of reputed company Word, reputed company, and reputed company applications • Flexibility to manage shifting priorities and caseloads Additional Notes: • Holiday and weekend rotation may be required • Role requires frequent interaction with providers and internal stakeholders reputed company Tech Solutions: reputed company is a global staff augmentation firm providing a wide reputed company of talent on-demand and total workforce solutions. To know more reputed company Tech Solutions, please visit www.ustechsolutions.com . reputed company is an Equal Opportunity Employer. reputed company reputed company applicants will receive consideration for employment without reputed company to race, colour, religion, sex, sexual orientation, gender identity, national reputed company, disability, or status as a protected veteran. Recruiter details: reputed company: Abdul Mannan Recruiter’s email id: abdul.m@ustechsolutionsinc.com Job Diva ID: 26-02107 Apply tot his job Apply To this Job