Night RN - Utilization Review & Reimbursement (Remote)

Trinity Health; United States; Remote; USD 85,000 - 110,000; Full time

Job summary

Trinity Health in the United States is seeking a Nurse Utilization Review professional for night shift, remote work. You will review cases for medical necessity and collaborate with the care team to ensure proper reimbursement.

Qualified candidates hold a BSN and Michigan RN license, with 3 years acute care experience; preferred: 2 years UM and audits. This role emphasizes autonomy and accountability within our patient-centered mission.

Qualifications

• BSN degree required.
• Current State of Michigan RN license.
• Three years acute care as an RN.
• Preferred: Two years recent acute care utilization management experience.
• Experience in facility audits/appeals and processes.
• Ability to work autonomously with accountability.

Responsibilities

• Perform all aspects of utilization review to ensure the medical necessity of acute care hospitalization has the existence of supportive documentation in the EMR.
• Provide all external review organizations the information necessary to complete reviews and effect maximum financial reimbursement.
• Collaborate with Case Management.
• Provides consultation and information to physicians, case managers and other members of the health care team.

Skills

Utilization review

RN

Remote work

Education

Bachelor of Science in Nursing (BSN)

Job description

Trinity Health in the United States is seeking a Nurse Utilization Review professional for night shift, remote work. You will review cases for medical necessity and collaborate with the care team to ensure proper reimbursement.

Qualified candidates hold a BSN and Michigan RN license, with 3 years acute care experience; preferred: 2 years UM and audits. This role emphasizes autonomy and accountability within our patient-centered mission.