Remote Utilization Review Specialist (RN)

Ampcus, Inc; Baltimore (MD); On-site; USD 90,000 - 110,000; Full time

Job summary

Ampcus Inc. is seeking an Utilization Review Specialist for a 3-month engagement. This role is fully remote in the United States, with standard hours 8:00 a.m. - 5:00 p.m.

EST (flexible). The specialist will perform prospective, concurrent, and retrospective reviews for authorization and appropriateness of care, leveraging clinical expertise and regulatory requirements. Requirements include an active RN license, 5+ years of clinical nursing, experience in managed care/utilization review,

Qualifications

• RN license required (State Licensure or Compact)
• Bachelor's degree in Nursing and 5+ years clinical nursing experience
• Experience with managed care and utilization review preferred

Responsibilities

• Determine medical necessity and appropriateness by referencing regulatory mandates, contracts, benefit information, and guidelines.
• Conduct research and analysis of diseases and treatments to support decisions and recommendations to medical directors.
• Make referrals and provide education to members/providers and assist with alternative care settings.

Skills

Clinical nursing

Care management

Utilization review

Microsoft Office

Regulatory knowledge

Communication skills

Education

Bachelor's degree in Nursing

Tools

Facets

Guiding Care

Job description

Ampcus Inc. is seeking an Utilization Review Specialist for a 3-month engagement. This role is fully remote in the United States, with standard hours 8:00 a.m. - 5:00 p.m.

EST (flexible). The specialist will perform prospective, concurrent, and retrospective reviews for authorization and appropriateness of care, leveraging clinical expertise and regulatory requirements. Requirements include an active RN license, 5+ years of clinical nursing, experience in managed care/utilization review,