Remote Utilization Review RN — Case Management Expert

HealthEdge Software, Inc.; Idaho; Remote; USD 80.000 - 110.000; Vollzeit

Zusammenfassung

HealthEdge Software, Inc. seeks an experienced Utilization Review RN to perform prospective, concurrent and retrospective reviews across inpatient and outpatient services, ensuring medical necessity and appropriate levels of care.

The role includes coordinating care, discharge planning, and addressing benefits and coordination of care for members. The ideal candidate will hold an RN license with 2+ years of clinical experience and may have Case Management certification in progress or preferred.

Qualifikationen

• Registered Nurse with current unrestricted RN license.
• Minimum of 2 years’ clinical experience in healthcare settings.
• Certification in Case Management preferred and encouraged.

Aufgaben

• Perform prospective, concurrent and retrospective review of inpatient, outpatient, ambulatory and ancillary services.
• Ensure medical necessity, appropriate length of stay, intensity of service and level of care.
• Coordinate care and discharge planning; analyze benefits and coordination of care.

Kenntnisse

Communication skills

Office software

Clinical criteria knowledge

Healthcare knowledge

Adaptability to remote work

Ausbildung

RN license

Tools

Microsoft Office

Jobbeschreibung

HealthEdge Software, Inc. seeks an experienced Utilization Review RN to perform prospective, concurrent and retrospective reviews across inpatient and outpatient services, ensuring medical necessity and appropriate levels of care.

The role includes coordinating care, discharge planning, and addressing benefits and coordination of care for members. The ideal candidate will hold an RN license with 2+ years of clinical experience and may have Case Management certification in progress or preferred.