Description

American Traveler is hiring an experienced RN for a fully remote Utilization Review position requiring a minimum of 5 years of RN experience and current UR experience with InterQual or Milliman criteria systems.

Details

• Fully remote position — no on-site reporting required
• Works within a managed care health plan environment, reviewing members in acute care, sub-acute, and acute rehabilitation settings
• No direct patient care — this is a medical review role only
• Schedule: Monday–Friday, 8:00 AM–5:00 PM EST
• No on-call, holiday, or weekend requirements
• EMR: Epic required; experience with referral platforms such as NaviHealth or AllScripts also required
• Experience with InterQual and/or Milliman criteria software systems required

Requirements

• Active MD or Compact RN license currently in hand
• Minimum 5 years of RN experience required
• Current utilization review (UR) experience required
• Managed care UR experience required; at least 1 year preferred
• Proficiency with Epic and referral platforms such as NaviHealth or AllScripts
• Proficiency with InterQual and/or Milliman criteria software systems
• Strong verbal and written communication skills with the ability to interact effectively with enrollees, physicians, facility staff, and management
• Computer proficiency with a variety of applications and online systems
• Ability to negotiate and resolve conflicts with external customers
• BLS certification is not required for this position
• SSN and DOB required for consideration
• One professional reference required for consideration

Additional Information

• Responsible for day-to-day management of health plan members confined in acute care and/or rehabilitative facilities
• Actively monitors appropriateness of care across acute hospital, sub-acute, and acute rehabilitation settings
• Applies member benefit and medical criteria to determine service authorization in coordination with Medical Directors
• Proactively initiates discharge planning, including identification of post-discharge needs and coordination of referrals and services
• Communicates authorization and/or denial of covered services verbally and in writing to providers, facilities, and members
• Functions as a member of both administrative and clinical teams
• Must maintain acceptable documentation standards and keep clinical knowledge current
• Candidate must provide their own equipment — no devices will be issued
• Local candidates are accepted at the same rate as travelers