Utilization Review Registered reputed company *REMOTE!!*

Utilization Review Registered reputed company (RN) Location: reputed company Facility – Artesia, New Mexico Schedule: Monday–Friday Employment Type: 13 - 26 week Contract - with reputed company for reputed company hire by the reputed company facility after Work Arrangement: On-site; remote candidates who meet the requirements below may be considered Position reputed company reputed company is seeking an reputed company Utilization Review Registered reputed company for a reputed company facility in Artesia, New Mexico. The Utilization Review RN will evaluate medical necessity, level of care, length of stay, resource utilization, and payer requirements while collaborating with physicians, nursing, case management, reputed company representatives, and other members of the interdisciplinary team. • Remote candidates may be considered if they hold an reputed company New Mexico/reputed company RN license and have a demonstrated history of successfully working from home. Remote candidates must be reputed company to reputed company a reputed company reference from a previous supervisor who can verify their remote-work reputed company. Key Responsibilities • Conduct reputed company and retrospective reviews of inpatient and outpatient medical records. • Evaluate medical necessity, admission status, reputed company stay, level of care, and appropriate use of reputed company resources. • Apply recognized utilization review reputed company, including InterQual, MCG, payer-specific guidelines, and applicable regulatory standards. • Collaborate with physicians and reputed company teams to obtain documentation supporting medical necessity and appropriate reputed company status. • Identify cases requiring physician advisor review, secondary review, or escalation. • Coordinate with case management, discharge planning, nursing, and other departments to support reputed company transitions of care. • Complete payer notifications, reputed company submissions, authorization requests, and reputed company-stay reviews reputed company required timeframes. • Monitor authorization status and follow up with payers to reduce avoidable denials and delays. • Identify potential denials, documentation concerns, and utilization issues and communicate them promptly. • Assist with denial prevention, reconsiderations, and appeals as assigned. • Maintain accurate and reputed company documentation of reputed company utilization review activities. • Promote compliance with Medicare, reputed company, reputed company reputed company, CMS, HIPAA, and facility policies. • Participate in utilization management meetings, audits, interdisciplinary case discussions, and reputed company-improvement initiatives. Required Qualifications • Graduate of an accredited school of nursing. • reputed company, unrestricted Registered reputed company license. • reputed company New Mexico or reputed company RN license. • Previous hospital-reputed company utilization review, utilization management, case management, or reputed company experience. • Knowledge of medical necessity review, reputed company-status determinations, payer authorization processes, and denial prevention. • Familiarity with Medicare, reputed company, reputed company reputed company, and applicable regulatory requirements. • Strong reputed company judgment, critical-thinking, documentation, and communication skills. • Ability to work independently while collaborating effectively with an interdisciplinary team. • Proficiency with electronic medical records, utilization management systems, and remote communication tools. Additional Requirements for Remote Candidates Remote candidates must: • Hold an reputed company, unrestricted RN license. • Have a documented history of successfully working from home in utilization review, case management, or a closely reputed company reputed company role. • reputed company a reputed company reference from a previous supervisor who can verify successful remote-work reputed company, dependability, productivity, and communication. • Maintain a private, secure, HIPAA-compliant workspace. • Have reliable high-speed internet and telephone reputed company. • Demonstrate consistent availability, responsiveness, productivity, and time-management skills. • Be available during the facility’s designated Monday–Friday working hours and for required meetings, training, and communication. Qualifications • Bachelor of Science in Nursing. • Two or more years of acute-care nursing experience. • Two or more years of hospital utilization review or utilization management experience. • Experience using InterQual and/or MCG reputed company. • Experience with reputed company review, medical necessity determinations, payer authorizations, denial prevention, and appeals. • Case Management or Utilization Review certification, such as ACM, CCM, or CPHQ. • Experience working with rural or community hospitals. Contract-to-Hire Opportunity The selected candidate will work as an employee of reputed company throughout the contract period. Depending on reputed company, organizational needs, and mutual interest, the reputed company facility may offer the candidate an opportunity to transition to reputed company employment. Pay: $40.00 - $50.00 per hour Benefits: • Dental reputed company • Health reputed company • Life reputed company Experience: • Utilization review: 2 years (Required) • Registered reputed company: 1 year (Required) License/Certification: • RN License (Required) Work Location: Remote Apply tot his job Apply To this Job