Description

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

Details

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

Requirements

• Active RN license (TX or multistate compact) required
• Minimum 2 years acute care utilization management experience or equivalent
• BLS certification required (AHA)
• Proficiency with InterQual/MCG criteria and CMS regulations required
• Nursys verification required within 30 days prior to start
• Current license and primary source verification required within 30 days prior to start
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Comfortable using multiple technology platforms simultaneously

Additional Information

• Reviews admissions and service requests for prospective, concurrent, and retrospective medical necessity and reimbursement compliance
• Provides case management and consultation for complex cases
• Assists staff with coding, documentation, precertification, reimbursement, and claims denial/appeal issues
• Coordinates discharge planning needs with healthcare team members
• Prepares statistical analysis and utilization review reports as needed
• Ensures compliance with federally mandated and third-party payer UM rules and regulations
• Requires critical thinking, independent judgment, and the ability to work with minimal supervision in a fast-paced environment
• Must have a US Social Security Number and a US home address
• Radius rule applies, allowing local candidates at a reduced rate depending on distance from facility