RN Care Navigator: Utilization & Care Coordination

United States Digital Space LLC

United States

Remote

USD 90,000 - 120,000

Full time

2 days ago

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Job summary

United States Digital Space LLC in Roseville, California seeks a skilled RN to manage utilization review for acute care. You will review medical records, determine appropriate settings and length of stay, and collaborate with healthcare providers and insurers to optimize care and resource use.

Requires an RN license, an Associate’s degree minimum, five years of acute hospital experience, and two years using Optum/InterQual. BSN preferred.

Qualifications

Associate’s Degree in nursing or equivalent required.
BSN preferred.
Five years' acute hospital experience required; critical care experience preferred.
Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months.

Responsibilities

Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay.
Participates in annual Optum/Inter Qual training and IRR test with a minimum passing score.
Meets weekly productivity metrics within 90 days of orientation and maintains on a weekly basis as defined in the goals.
Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions.
Collaborates with healthcare professionals to develop and implement comprehensive patient care plans and coordinates with insurers.
Performs other job-related duties as assigned.