Description

American Traveler is hiring a remote Utilization Management RN with 2+ years of acute care UM experience and InterQual/MCG proficiency.

Details

• Fully remote position within a centralized Utilization Management department
• Provides centralized acute admission utilization review across 13 acute care and critical access hospitals
• Uses Cerner EMR with Careport (Allscripts)
• Day shift schedule from 08:30 to 17:00
• 13-week assignment

Requirements

• Active RN license (TX or Compact) required
• BLS certification required (AHA)
• Minimum 2 years acute care utilization management experience or equivalent required
• Proficiency with InterQual/MCG and CMS regulations required
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Proficient and adaptable with multiple technologies simultaneously
• Nursys license verification required within 30 days prior to start

Additional Information

• Reviews admissions and service requests for medical necessity and compliance with reimbursement policy criteria on a prospective, concurrent, and retrospective basis
• Provides case management and consultation for complex cases
• Assists staff with coding, medical records/documentation, precertification, reimbursement, and claim denial/appeal issues
• Coordinates discharge planning needs with the healthcare team
• Prepares statistical analysis and utilization review reports as needed
• Oversees compliance with federally mandated and third-party payer utilization management rules and regulations
• Requires strong critical thinking, decisive judgment, and the ability to work independently in a fast-paced, stressful environment
• Local candidates accepted, subject to a radius rule that may affect pay rate
• Candidates must have a US Social Security Number and provide a US home address