Utilization Review Nurse RN - Remote | WFH
Utilization Review Nurse RN - Remote | WFH
Get It Recruit - Healthcare
Nashville, TN
See who Get It Recruit - Healthcare has hired for this role
Role Summary
The Utilization Review RN Case Manager will collaborate to ensure quality care and cost-effective outcomes that enhance the physical, psychosocial, and vocational health of plan participants. This role operates in compliance with industry standards and regulations.
Daily Responsibilities
As the Utilization Review RN Case Manager, you will oversee all aspects of the utilization review process under the direction of the Utilization Review Supervisor. Responsibilities include inpatient and outpatient reviews, admission and discharge planning, retrospective and readmission reviews, and large case management. You will identify potential large claims, develop quality improvement programs, and maintain communication with medical and payer stakeholders. Adherence to URAC requirements and documentation standards is essential. Additionally, you will provide customer service support and ensure timely communication with internal and external parties.
Qualifications
Registered Nurse with at least 5 years of clinical nursing experience
Bachelor's Degree and/or Certification in UR, Case Management, or related field (preferred)
Strong written and oral communication skills
Positive, proactive team-oriented attitude
Proficiency in computer skills
Active, unrestricted RN license valid in the United States
Other Requirements
Completion of LHCM Orientation and Training Course
Familiarity with URAC UM Standards and clinical review guidelines
Ability to supervise non-clinical administrative staff as needed
Proficiency in using telephones, servers, and other software provided by the organization
Additional Information
This job operates Monday to Friday from 9am to 6pm EST with occasional late shifts and on-call duties.
Remote work-from-home position with required occasional in-person training in downtown Nashville.
Oncology Experience Preferred.
Equal Opportunity Employer statement applies.
Employment Type: Full-Time
The Utilization Review RN Case Manager will collaborate to ensure quality care and cost-effective outcomes that enhance the physical, psychosocial, and vocational health of plan participants. This role operates in compliance with industry standards and regulations.
Daily Responsibilities
As the Utilization Review RN Case Manager, you will oversee all aspects of the utilization review process under the direction of the Utilization Review Supervisor. Responsibilities include inpatient and outpatient reviews, admission and discharge planning, retrospective and readmission reviews, and large case management. You will identify potential large claims, develop quality improvement programs, and maintain communication with medical and payer stakeholders. Adherence to URAC requirements and documentation standards is essential. Additionally, you will provide customer service support and ensure timely communication with internal and external parties.
Qualifications
Registered Nurse with at least 5 years of clinical nursing experience
Bachelor's Degree and/or Certification in UR, Case Management, or related field (preferred)
Strong written and oral communication skills
Positive, proactive team-oriented attitude
Proficiency in computer skills
Active, unrestricted RN license valid in the United States
Other Requirements
Completion of LHCM Orientation and Training Course
Familiarity with URAC UM Standards and clinical review guidelines
Ability to supervise non-clinical administrative staff as needed
Proficiency in using telephones, servers, and other software provided by the organization
Additional Information
This job operates Monday to Friday from 9am to 6pm EST with occasional late shifts and on-call duties.
Remote work-from-home position with required occasional in-person training in downtown Nashville.
Oncology Experience Preferred.
Equal Opportunity Employer statement applies.
Employment Type: Full-Time
-
Seniority level
Mid-Senior level -
Employment type
Full-time -
Job function
Health Care Provider -
Industries
Human Resources Services
Referrals increase your chances of interviewing at Get It Recruit - Healthcare by 2x
See who you knowGet notified about new Utilization Review Nurse jobs in Nashville, TN.
Sign in to create job alertSimilar jobs
People also viewed
-
Prior Authorization Nurse
Prior Authorization Nurse
-
Professional Review Nurse - Remote | WFH
Professional Review Nurse - Remote | WFH
-
Care Management RN (Compact License)
Care Management RN (Compact License)
-
Clinical Review Nurse
Clinical Review Nurse
-
Healthcare - Medical Claim Review Nurse
Healthcare - Medical Claim Review Nurse
-
RN Lactation Consultant - Neonatal ICU - Remote | WFH
RN Lactation Consultant - Neonatal ICU - Remote | WFH
-
Utilization Management RN (Compact Licensed)
Utilization Management RN (Compact Licensed)
-
Lead Clinical RN Quality Assurance - Long Term Disability, Remote
Lead Clinical RN Quality Assurance - Long Term Disability, Remote
-
Clinical Review Nurse
Clinical Review Nurse
-
Nurse Auditor, Hospital Bill Audits - Remote | WFH
Nurse Auditor, Hospital Bill Audits - Remote | WFH
Looking for a job?
Visit the Career Advice Hub to see tips on interviewing and resume writing.
View Career Advice Hub