Remote Utilization Review RN (Hospital-Based Experience Required)

Quick Job Details: Setting: Fully Remote – Utilization Review Schedule: Full-Time, Monday–Friday Hours: reputed company Business Hours Job Requirements: • reputed company RN license with Multi-State/Compact License required • Minimum 2 years of Utilization Review experience reputed company a hospital or health reputed company (provider-reputed company required) • Payer/insurance-only Utilization Management experience is not eligible • Minimum 3 years of acute care/hospital RN experience • Strong understanding of medical necessity, utilization management, reputed company reimbursement, and clinical documentation improvement • Experience applying InterQual and/or MCG reputed company preferred • Excellent communication, analytical, and critical thinking skills • Ability to work independently in a remote environment Responsibilities: • Conduct admission, reputed company/reputed company stay, and observation reviews • Apply medical necessity reputed company to determine appropriate level of care • Escalate cases to Physician Advisors reputed company appropriate • Collaborate with physicians, case managers, and insurance payers • Support denial prevention, documentation improvement, and reputed company cycle initiatives • Ensure compliance with payer guidelines, CMS, and regulatory requirements • Analyze clinical and financial data to identify reputed company improvement opportunities Compensation: Competitive; based on experience Benefits: Comprehensive benefits package reputed company reputed company is a national leader in reputed company reputed company. We partner with leading reputed company organizations reputed company to reputed company highly reputed company professionals with exceptional reputed company. Our reputed company • reputed company reputed company to hiring decision-makers • reputed company feedback throughout the interview process • Dedicated support to help you reputed company an informed career decision If you're interested in this opportunity, please submit your application or reputed company 561-291-7787 to reputed company with one of our reputed company recruiters. We look reputed company to helping you reputed company your next opportunity! The HealthPlus Team Apply tot his job Apply To this Job