Remote RN Case Manager - Utilization Review

Cynet Health; Austin (TX); On-site; USD 55,000 - 96,000; Full time

Job summary

Cynet Health is seeking a Registered Nurse Case Manager for a 13-week assignment in Austin, TX. This role focuses on utilization review, discharge planning, and complex case management, requiring 2+ years acute care UM experience and a TX RN license.

Proficiency with InterQual/MCG and CMS regulations is essential; familiarity with payer portals and managed Medicare/Medicaid insurers is a plus. Remote work experience is noted.

Qualifications

• Minimum 2 years acute care utilization management experience
• Licensed RN (TX or multi-state)
• BLS certification required
• Experience with case management and discharge planning is a plus
• Knowledge of InterQual/MCG and CMS guidelines

Responsibilities

• Provides health care services regarding admissions, case management, discharge planning, and utilization review.
• Reviews admissions and service requests for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria.
• Provides case management and consultation for complex cases.
• Assists departmental staff with issues related to coding, medical records, documentation, precertification, reimbursement, and claim denials or appeals.
• Assesses and coordinates discharge planning needs with healthcare team members.
• May prepare statistical analysis and utilization review reports as necessary.
• Oversees and coordinates compliance with federally mandated and third-party payer utilization management rules and regulations.
• Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision.
• Must be able to work in a stressful environment.

Skills

InterQual/MCG

CMS regulations

Remote work

Payer portals

Tools

Payer portals

Job description

Cynet Health is seeking a Registered Nurse Case Manager for a 13-week assignment in Austin, TX. This role focuses on utilization review, discharge planning, and complex case management, requiring 2+ years acute care UM experience and a TX RN license.

Proficiency with InterQual/MCG and CMS regulations is essential; familiarity with payer portals and managed Medicare/Medicaid insurers is a plus. Remote work experience is noted.