Remote Utilization Review Nurse - Acute Care Expert

Insight Global; North Carolina; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality policies. The ideal candidate has over 2 years of experience in utilization review and significant clinical experience in an acute setting. Strong written and verbal communication skills are essential.

Qualifications

• Minimum 2 years of Utilization Review experience on the payer side.
• At least 5 years of clinical experience in an acute environment.
• 1+ year experience with MCG and InterQual tooling.

Responsibilities

• Evaluate patient care cases per hour for inpatient and outpatient.
• Assess patient care requests for medical services.
• Collaborate with providers to ensure medical necessity.

Skills

Utilization Review experience

Clinical experience in acute environment

Proficiency in Google Suite Applications

Attention to detail

Flexibility

Written and verbal communication

Education

Associate Degree or Bachelor's Degree in Nursing

Tools

MCG and InterQual tooling

MacBook proficiency

Job description

A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality policies. The ideal candidate has over 2 years of experience in utilization review and significant clinical experience in an acute setting. Strong written and verbal communication skills are essential.