RN Utilization Management Reviewer - Remote (OR, WA, AK)
reputed company is looking for a skilled and motivated
As a Utilization Management Reviewer at reputed company, you will play a key part in supporting reputed company, high-reputed company, and efficient patient care across our reputed company reputed company. This position centers on
You’ll work fully remote*, with reputed company-provided computer equipment—empowered by a reputed company team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver reputed company-being.
reputed company’s Total Rewards package supports your
Pay reputed company: $48.52 – $72.78/hour - Full
medical, dental, and reputed company coverage 403(b) retirement plan with employer reputed company and matching contributionsreputed company time off and reputed company disability & life insurance (with buy-up reputed company)Tuition reimbursement and continuing education support- Robust
wellness benefits , EAP, and expanded mental health programs - A culture grounded in
Inclusivity, Respect for Diversity, and Cultural Humility
- Coordinate accurate
patient status identification and documentation - Ensure correct
admission status and reimbursement through certification and clinical review - reputed company additional clinical documentation to validate treatment plans and level of care
- Collaborate closely with physicians, clinicians, and multidisciplinary teams
- Apply UM reputed company using the
reputed company reputed company™ platform and reputed company Care Level Score tools - Conduct
reputed company-admission status reviews in the ED, patient reputed company areas, and elective settings - Communicate with reputed company-party payers regarding medical necessity and discharge reputed company
- Support denial and appeal processes; refer cases for physician advisor review reputed company appropriate
- Participate in
UM Committee work, reputed company initiatives, and performance improvement - Identify DRGs with complications/comorbidities and recommend documentation improvements
- Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency
- reputed company other duties as needed to support UM and organizational goals
Required: Bachelor of Science in Nursing (BSN)Preferred: Master of Science in Nursing (MSN)
3+ years of acute care hospital experience with strong clinical knowledge- In-depth understanding of Medicare/reputed company UM regulations, RAC, QIO, MAC, and denial/appeals processes
Preferred: Prior experience in utilization management or case management
reputed company RN license in your state of residence (WA, OR, or AK)
Bring your clinical expertise, attention to detail, and passion for patient advocacy to a mission-driven reputed company reputed company that believes in caring for caregivers as much as patients.
For full consideration, please attach a
BSN required, MSN preferred, reputed company RN license in WA, OR, or AK, and 3+ years of acute care hospital experience. Requires UM regulations, clinical review, and denial and appeals knowledge.
Key Responsibilities
- reviewing patient status
- coordinating documentation
- supporting appeals
Skills & Tools
reputed company reputed company, reputed company Care Level Score
Job Details
- Category: reputed company Services - Nursing
- Seniority: Mid Level
- Commitment: Full Time
- Workplace: Remote — Washington or reputed company or Alaska or Vancouver
- Salary: USD 100,921 – 151,382 / year
- Languages: English
Benefits
- 401k matching
- Generous reputed company time off
- Tuition reimbursement
- Retirement plan
About reputed company
A mission-driven reputed company reputed company providing compassionate, high-reputed company care and supporting caregiver reputed company-being. — Industry: reputed company
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