We're on the lookout for a highly motivated and seasoned Utilization Review Nurse to become a valuable member of our team. As a Utilization Review Nurse, you'll play a pivotal role in supporting our clients within the healthcare sector, offering expert clinical guidance, facilitating efficient utilization management, and ensuring smooth revenue cycle operations. This position presents an exciting opportunity to blend clinical expertise with revenue cycle management know-how.
Key Responsibilities:
Clinical Assessment: Conduct thorough clinical assessments of medical records to ensure patients receive optimal care at the appropriate level of service.
Care Coordination: Collaborate with interdisciplinary healthcare teams to coordinate patient care and treatment plans, ensuring cost-effective and clinically sound care delivery.
Revenue Cycle Management: Leverage clinical expertise to support revenue cycle processes, including accurate coding, documentation enhancement, and compliance with healthcare regulations.
Utilization Review:
Apply medical necessity screening criteria and clinical knowledge to assess the appropriateness of admissions and length of stays.
Perform initial admission, continuing stay, and 23-hour observations reviews for all patients.
Assist Utilization Review Coordinator team members with escalated cases for level of care determinations.
Screen cases for Physician Advisor review and collaborate with insurance companies on concurrently denied and high-risk denial cases.
Documentation Improvement: Identify opportunities to enhance clinical documentation, aiding in accurate coding and billing processes to optimize reimbursement.
Data Analysis: Analyze clinical and financial data to spot trends, identify improvement opportunities, and pinpoint areas for potential cost savings for clients.
Compliance: Stay abreast of healthcare regulations, guidelines, and policies to ensure all patient care and revenue cycle processes comply with industry standards and regulatory requirements, ensuring appropriate reimbursement.
Qualifications:
Registered Nurse (RN) licensure in the state of practice.
Bachelor of Science in Nursing (BSN) preferred.
Epic experience and proficiency.
Case Management Certification (e.g., CCM) is advantageous.
Minimum of 3 years of clinical nursing experience, preferably in a hospital or acute care setting.
Strong grasp of revenue cycle management and healthcare reimbursement.
Proficiency in medical coding and clinical documentation improvement.
Excellent communication, interpersonal, and teamwork skills.
Ability to work independently and make informed clinical and financial decisions.
Strong analytical and problem-solving skills.
Proficient in using healthcare information systems and technology.
Commitment to upholding patient confidentiality and ethical standards.
Benefits:
Flexible hours.
Work Context:
With a 100% remote workforce, effective communication and remote relationship-building skills are paramount. If you're a skilled Utilization Review Nurse passionate about improving patient care and optimizing revenue cycle processes, we invite you to apply for this exciting opportunity with our team. Join us in making a positive impact on the healthcare industry, helping healthcare providers achieve financial success while delivering top-notch patient care.
Note:
This job description does not limit duties to those mentioned above. Employees may be required to perform additional job-related tasks as requested. All duties are subject to reasonable modification to accommodate individuals with disabilities. This document does not constitute an employment contract; it establishes an "at-will" relationship.
Employment Type: Per Diem
Salary: $ 35.00 50.00 Per Hour
