Remote Inpatient Utilization Review Nurse

WellSense Health Plan; Charlestown (NH); On-site; USD 50,000 - 72,000; Full time

Benefits offered by this job

Full-time remote work

Competitive salaries

Excellent benefits

Job summary

WellSense Health Plan is seeking an Inpatient Utilization Management Clinician for a fully remote role in the United States. You will evaluate inpatient medical necessity, monitor treatment, and coordinate discharge planning with care management and medical directors to drive optimal outcomes.

Qualifications include an active RN license, nursing degree, and 2 years of utilization review experience with InterQual.

Qualifications

• Active, unrestricted RN license in the state of residence.
• Nursing degree or diploma required; bachelor's in nursing preferred.
• 2 years utilization review experience with InterQual guidelines and managed care experience.
• Experience performing discharge planning and working remotely is required.

Responsibilities

• Performs utilization review using InterQual and Medical Policy.
• Obtains clinical information from EMR to assess decisions.
• Determines medical appropriateness of inpatient services per guidelines.
• Documents and communicates all utilization review activities and outcomes.
• Refers cases to Physician Reviewer when medical necessity is not met or guidelines unavailable.
• Monitors inpatient cases for regulatory compliance and timely reviews.
• Participates in discharge planning discussions with care management.
• Identifies delays in care and escalates to MD as needed.
• Supports team training and participates in meetings.

Skills

Communication skills

Clinical judgement

Interpersonal skills

Remote independent work

MS Office proficiency

Time management

Analytical problem solving

Education

Nursing degree or diploma

Bachelor's degree in nursing

Tools

Microsoft Office

Job description

WellSense Health Plan is seeking an Inpatient Utilization Management Clinician for a fully remote role in the United States. You will evaluate inpatient medical necessity, monitor treatment, and coordinate discharge planning with care management and medical directors to drive optimal outcomes.

Qualifications include an active RN license, nursing degree, and 2 years of utilization review experience with InterQual.