Description

American Traveler is hiring a remote Utilization Management RN requiring a TX or compact RN license and 2 years of acute care UM experience.

Details

• Fully remote position supporting a centralized Utilization Management department
• Provides centralized acute admission utilization review across 13 acute care and critical access hospitals
• Uses Cerner with Careport (Allscripts) EMR
• Day shift schedule from 08:30 to 17:00
• No floating required

Requirements

• Active RN license (multistate or TX)
• Current BLS certification (AHA)
• Minimum 2 years acute care utilization management experience or equivalent
• Proficiency with InterQual/MCG and CMS regulations required
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Comfortable using multiple technologies simultaneously
• Nursys license verification required within 30 days prior to start
• Must provide full SS# and DOB, copy of driver's license, and 2 separate references for consideration

Additional Information

• Review admissions and service requests for medical necessity and compliance with reimbursement policy criteria
• Provide case management and consultation for complex cases
• Assist staff with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals
• Assess and coordinate discharge planning needs with the healthcare team
• Prepare statistical analysis and utilization review reports as needed
• Oversee and coordinate compliance with federally mandated and third-party payer utilization management rules and regulations
• Requires strong critical thinking, decisive judgment, and ability to work independently in a fast-paced environment
• Must have a US Social Security Number and US home address
• Radius rule applies allowing local candidates at a reduced rate, which varies by state
• COVID vaccination is not required