Description

American Traveler is seeking an experienced RN for a remote Utilization Management position requiring strong utilization review and Epic EMR experience.

Details

• Work setting is fully remote
• Focus on Utilization Management for health plan members in acute care and rehabilitation settings
• Day shifts, Monday through Friday, 8:00 AM to 5:00 PM EST
• No direct patient care is involved, strictly medical review responsibilities
• Uses Epic EMR and referral platforms like NaviHealth or AllScripts
• Application of InterQual and/or Milliman criteria software systems to determine service authorizations

Requirements

• Active RN license (MD or compact)
• Minimum 5 years of RN experience required
• Current utilization review experience required
• At least 1 year of managed care utilization review experience preferred
• Experience with Epic EMR, NaviHealth or AllScripts, and InterQual and/or Milliman criteria required
• Experience in facilities with 500+ bed count required

Additional Information

• Responsible for daily management and review of care for health plan members in acute and rehabilitative settings
• Collaborate with Medical Directors to determine service authorizations and initiate discharge planning
• Communicate authorizations and denials to providers, facilities, and plan members both verbally and in writing
• Maintain clinical knowledge and meet documentation and quality standards
• Strong verbal, written, and interpersonal communication skills required
• Computer proficiency and ability to work with multiple online systems is essential
• Must be able to negotiate and resolve conflicts with external customers
• Locals are eligible except for Howard County General where a 60-mile radius rule applies