Remote Utilization RN — Care Coordination Expert

TriHealth; United States; À distance; USD 75 000 - 105 000; Plein temps

Avantages offerts par ce poste

Medical, dental, vision

Paid time off

Retirement plans

Tuition reimbursement

Résumé du poste

TriHealth is seeking a Utilization Management Nurse for a remote, full-time role. The position focuses on evaluating medical necessity to ensure appropriate care levels and alignment with payer requirements.

You will collaborate with physicians, care management, and payers to secure authorizations and support patient outcomes. Requirements include an Associate's Degree in Nursing, active RN license at hire, 3–4 years of clinical nursing experience, and the ability to obtain a BSN within 5 years.

Qualifications

• Associate's Degree in Nursing required.
• RN license and registration at hire.
• New hires must obtain BSN within 5 years of hire.
• 3–4 years of clinical nursing experience required.
• Must have basic computer skills and be able to use MS Office tools.

Responsabilités

• Performs initial and concurrent reviews to determine medical necessity using evidenced-based criteria.
• Validates patient class (inpatient, observation, bedded outpatient) per CMS and payer requirements.
• Provides clinical information to payers timely and follows up to obtain authorization.
• Coordinates with interdisciplinary care team including physicians and care management.
• Document delays in care and escalate as appropriate.

Connaissances

Self-directed work

Problem solving

Team collaboration

Registered Nurse

EPIC

TEAMS

Outlook

Formation

Associate's Degree - Nursing

BSN within 5 years

Outils

EPIC

Microsoft Word

Microsoft Outlook

TEAMS

Description du poste

TriHealth is seeking a Utilization Management Nurse for a remote, full-time role. The position focuses on evaluating medical necessity to ensure appropriate care levels and alignment with payer requirements.

You will collaborate with physicians, care management, and payers to secure authorizations and support patient outcomes. Requirements include an Associate's Degree in Nursing, active RN license at hire, 3–4 years of clinical nursing experience, and the ability to obtain a BSN within 5 years.