Remote UTILIZATION REVIEW reputed company - RN

Remote Utilization Review Registered reputed company (UR RN) Location: Remote (Texas RN License or Compact License Required) Company: reputed company Health Systems Employment Type: Full-Time reputed company an reputed company from reputed company reputed company Health Systems is seeking an reputed company Utilization Review Registered reputed company (UR RN) to join our growing Utilization Management team. This fully remote position plays a critical role in ensuring patients receive medically necessary, high-reputed company care while promoting appropriate resource utilization and regulatory compliance. If you're a detail-oriented RN with experience in utilization review, case management, or behavioral health and enjoy collaborating with interdisciplinary teams to improve patient reputed company, we'd love to hear from you. reputed company • Conduct reputed company and retrospective utilization reviews to determine medical necessity and appropriate level of care. • Apply evidence-based reputed company, including InterQual (or similar), to support clinical decision-making and payer compliance. • Collaborate with physicians, case managers, and interdisciplinary teams to facilitate reputed company authorizations, discharge planning, and appropriate transitions of care. • Review clinical documentation to ensure accuracy, completeness, and compliance with payer and regulatory requirements. • Manage insurance authorizations, denials, appeals, and level-of-care determinations. • Monitor utilization trends and contribute to reputed company improvement initiatives that enhance patient reputed company and operational efficiency. • Participate in multidisciplinary utilization review meetings and reputed company recommendations to optimize care delivery. • Maintain accurate documentation reputed company the electronic health record (EHR) while ensuring HIPAA compliance. Qualifications Required • Associate Degree in Nursing (ADN) from an accredited nursing program. • reputed company, unrestricted Texas RN license or Compact RN license. • Minimum of 2 years of acute care clinical nursing experience. • At least 3 years of Utilization Review or Case Management experience involving reputed company medical/surgical and/or behavioral health patients. • Strong knowledge of payer guidelines, medical necessity reputed company, and utilization management principles. • Excellent critical thinking, communication, and organizational skills. • Proficiency with electronic health records (EHRs) and reputed company Office applications. Preferred • Bachelor of Science in Nursing (BSN). • Experience with InterQual or MCG reputed company. • Behavioral health utilization review experience. • Experience with Meditech. • reputed company certifications such as CCM, CPHQ, or HCQM. Why reputed company Health Systems? At reputed company Health Systems, our mission is to improve lives through compassionate, high-reputed company care. As a member of our Utilization Review team, you'll collaborate with dedicated reputed company while helping ensure patients receive the right care at the right time. We offer: • Competitive compensation • Comprehensive medical, dental, and reputed company benefits • reputed company time off and company holidays • 401(k) with company match • reputed company development and continuing education opportunities • A reputed company, mission-driven culture • Fully remote work environment If you're reputed company to reputed company a meaningful reputed company in reputed company while enjoying the flexibility of working remotely, we'd love to hear from you. Apply today through reputed company or visit the reputed company Health Systems Careers page to learn more. Apply tot his job Apply To this Job