Remote RN Utilization Lead — UM/UR & CDI

Omega Healthcare Solutions; Oregon; Hybrid; USD 90,000 - 150,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Professional development

Job summary

Omega Healthcare Solutions is seeking a seasoned Utilization Management RN to conduct medical necessity reviews and coordinate payer authorizations. The role emphasizes leadership of Care Coordination/UR staff and collaboration with physicians and hospital leadership to optimize patient status and length of stay.

Work is performed in a remote home office with standard office equipment; candidates should have a BSN, current RN license, 3–5 years UR experience, and familiarity with InterQual,

Qualifications

• BSN or higher degree in nursing or healthcare field.
• Active, unrestricted RN license.
• 3–5 years of hospital-based Utilization Review/Utilization Management experience.
• Knowledge of InterQual criteria, Medicare regulations, and inpatient vs observation status.
• Experience mentoring staff and leading process improvements.
• Understanding Medicare Part A and Part B, DRG assignment, MCC/CC impact.

Responsibilities

• Review medical necessity and patient status using InterQual and Medicare guidelines.
• Coordinate payer authorizations and physician escalations to reduce delays.
• Develop and standardize UM/UR workflows and escalation processes.
• Provide leadership and mentorship to Care Coordination/UR staff.
• Collaborate with physicians and hospital leadership to optimize utilization and LOS.
• Monitor KPIs and generate utilization and LOS reports.
• Support early medical necessity review processes, including ED and admissions.
• Provide CDI support, including concurrent reviews and provider queries.
• Additional training in Access, DRG assignment, MCC/CC knowledge.

Skills

InterQual criteria

Medicare regulations

Payer policy knowledge

Mentoring staff

Leadership and collaboration

Problem solving

Documentation improvement

Epic EMR

Education

BSN

RN license

Tools

Epic EMR

Job description

Omega Healthcare Solutions is seeking a seasoned Utilization Management RN to conduct medical necessity reviews and coordinate payer authorizations. The role emphasizes leadership of Care Coordination/UR staff and collaboration with physicians and hospital leadership to optimize patient status and length of stay.

Work is performed in a remote home office with standard office equipment; candidates should have a BSN, current RN license, 3–5 years UR experience, and familiarity with InterQual,