Utilization Review Registered Nurse

Overview

• This contract position offers remote work flexibility within the United States.
• The role requires a California Registered Nurse license and utilization review experience.
• Candidates will perform Medicare-related utilization reviews, adhering to the 2-Midnight rule.
• Utilize Interqual and Xsolis tools for case management and decision-making.
• Manage a caseload of up to 42 cases daily, ensuring efficiency and accuracy.
• Work every other weekend, maintaining consistent performance standards.
• Collaborate with healthcare professionals to optimize patient care and resource utilization.

Key Responsibilities & Duties

• Conduct utilization reviews to determine medical necessity and compliance with Medicare guidelines.
• Apply the 2-Midnight rule for inpatient service evaluations under Medicare Part A.
• Leverage Interqual and Xsolis tools for case assessments and documentation.
• Manage a high-volume caseload, ensuring timely and accurate reviews.
• Collaborate with multidisciplinary teams to enhance patient care plans.
• Ensure compliance with regulatory and organizational standards.
• Provide detailed reports and documentation for reviewed cases.

Job Requirements

• Active California Registered Nurse (RN) license is mandatory.
• Bachelor of Science in Nursing (BSN) degree required.
• Minimum of 2 years of utilization review experience.
• Proficiency in Medicare guidelines and the 2-Midnight rule.
• Experience with Interqual and Xsolis tools is essential.
• Ability to manage a caseload of up to 42 cases daily.
• Availability to work every other weekend.