Utilization Management RN - Remote

Job Family:

Travel Required:

Clearance Required:

What You Will Do:

• Performs chart review of identified patients to identify quality, timeliness and appropriateness of patient care

• Conducts admission reviews for Medicare, Medicaid beneficiaries, as well as private insurers and self-pay patients, based on appropriate guidelines

• Uses these criteria guidelines to screen for appropriateness for inpatient level of care or observation services based on physician certification

• Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis

• Performs concurrent and retrospective clinical reviews with various payers, utilizing the app...