Inpatient Clinical Utilization Reviewer RN

Ustech Solutions Inc; United States; Remote; USD 55,000 - 76,000; Part time

Job summary

US Tech Solutions seeks an experienced Clinical Reviewer, Inpatient RN to manage a clinically complex caseload across inpatient settings including acute and subacute care. The role requires determining medical necessity and benefit coverage for Medicare and public plans, while working independently and with the team.

Responsibilities include utilization management, discharge planning, and collaborating with providers to ensure smooth transitions in the continuum of care.

Qualifications

• RN license in Massachusetts (active/unrestricted)
• BSN is preferred
• UM/inpatient nursing experience is required

Responsibilities

• Manage clinically complex caseload across inpatient settings
• Determine medical necessity and benefit coverage
• Perform utilization management and discharge planning
• Collaborate with providers to facilitate transitions in care

Skills

Interpersonal skills

Communication

Negotiation

Time management

Independent work

Flexibility

Mentoring

Standards application

Team collaboration

Technical proficiency

Education

Registered Nurse with MA license

BSN preferred

Tools

Microsoft Word

Microsoft Excel

Job description

US Tech Solutions seeks an experienced Clinical Reviewer, Inpatient RN to manage a clinically complex caseload across inpatient settings including acute and subacute care. The role requires determining medical necessity and benefit coverage for Medicare and public plans, while working independently and with the team.

Responsibilities include utilization management, discharge planning, and collaborating with providers to ensure smooth transitions in the continuum of care.