Utilization Review Nurse - RN, LPN, or LCSW (Remote)
Utilization Review Nurse - RN, LPN, or LCSW (Remote)
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Job Description
Job Summary:
As a Utilization Management Nurse/Social Worker youll play a crucial role in our multidisciplinary team ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses. Proficient in Utilization Review processes youll maintain effective procedures to meet regulatory and reimbursement requirements for various payers both commercial and government.
100% Remote - However Only Nevada Licenses are Considered
Key Responsibilities:
- Conduct concurrent and continued stay Utilization Management reviews ensuring accurate data tracking evaluation and reporting.
- Lead or participate actively in process improvement initiatives collaborating with various departments and multi-disciplinary teams.
- Efficiently manage a diverse workload in a fast-paced ever-evolving regulatory environment.
- Foster positive collaboration with the Care team to facilitate timely patient progression during their stay.
Job Requirements:
- Current Nurse license or Clinical License in Nevada.
- Associates degree; Bachelors degree preferred.
- 3-5 years of acute hospital experience and 3 years of Utilization Management experience in large health organization.
- Hospital case management experience is advantageous.
- Proficiency in federal and state regulations (DOH Medicaid/Medicare) and familiarity with third-party payers and managed care principles.
Salary Range:$80000
Benefits: Yes- Full benefit package available with employer contribution.
Join our dynamic team and be part of our commitment to efficient Utilization Management and patient-focused care.
Date of Original Job Posting: 12/10/24
Employment Type
Full Time
