Remote Utilization Review Registered Nurse

Remote Utilization Review Registered Nurse Overview

• The Remote Utilization Review Registered Nurse role offers a flexible work-from-home opportunity within the healthcare industry.
• Utilize your California RN license to perform utilization reviews and ensure compliance with Medicare guidelines.
• Work with advanced AI-integrated systems like Interqual and Xsolis to manage patient cases effectively.
• Handle 42 cases daily, applying the 2-Midnight rule for inpatient services under Medicare Part A.
• Collaborate remotely with healthcare teams to optimize patient care and resource utilization.
• Contribute to a dynamic and fast-paced environment requiring precision and efficiency.
• Ensure adherence to regulatory standards and promote quality healthcare delivery.
• Participate in weekend shifts as part of the role's requirements.

Remote Utilization Review Registered Nurse 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.
• Utilize Interqual and Xsolis systems for case management and decision-making.
• Manage a daily caseload of 42 patient reviews, ensuring accuracy and timeliness.
• Collaborate with healthcare providers to optimize patient care plans and resource allocation.
• Ensure compliance with regulatory standards and organizational policies.
• Provide detailed documentation and reporting for all utilization review activities.
• Participate in weekend shifts as required, maintaining consistent performance standards.

Remote Utilization Review Registered Nurse Job Requirements

• Active California RN license with a minimum of 2 years of utilization review experience.
• Proficiency in Medicare guidelines, including the 2-Midnight rule for inpatient services.
• Experience with Interqual and Xsolis systems for case management.
• Ability to manage a caseload of 42 patient reviews daily with precision.
• Comfortable working remotely and participating in weekend shifts as required.
• Associate of Science (AS) degree in Nursing or equivalent educational background.
• Strong analytical and organizational skills to ensure compliance and efficiency.
• Effective communication skills for collaboration with healthcare teams.