RN Utilization Review Specialist

VieMed; Lafayette (LA); In loco; USD 65.000 - 85.000; Tempo pieno

Descrizione del lavoro

Sleep Management, LLC in Lafayette, LA is seeking a qualified Registered Nurse to join our clinical review team. You will assess medical records, determine coverage eligibility, and ensure documentation aligns with payer requirements.

This on-site role offers Monday–Friday daytime hours and requires strong attention to detail, excellent communication, and independent work across departments. As an RN with Medicare/Medicaid knowledge, you will evaluate diagnoses and orders, escalate complex

Competenze

• Current, active RN license in good standing.
• Clinical nursing experience with chart-review capability.
• Ability to apply nursing knowledge and professional judgement.
• Ability to read and interpret diagnoses and physician orders.
• Strong detail orientation and accurate documentation.
• Excellent written and verbal communication with physicians, insurers, and staff.
• Ability to manage multiple chart reviews and meet turnaround goals.
• Ability to work independently and collaboratively across departments.
• Proficiency with EMR and MS Office is required.

Mansioni

• Conduct clinical reviews of patient records to evaluate therapies and coverage.
• Review physician orders and clinical documentation for completeness.
• Identify missing or unclear information and request clarifications.
• Apply nursing knowledge to assess medical necessity and treatment history.
• Provide recommendations on referral readiness and next steps.
• Evaluate documentation against Medicare/Medicaid and payer criteria.
• Maintain compliant documentation in the system.
• Escalate complex questions to management.
• Perform other duties as assigned.

Conoscenze

RN license

Clinical nursing

Nursing judgement

Medicare/Medicaid knowledge

Medical terminology

Attention to detail

Communication skills

Multitasking

EMR proficiency

Office suite

Strumenti

EMR systems

Microsoft Office

Outlook

Word

Excel

Descrizione del lavoro

Sleep Management, LLC in Lafayette, LA is seeking a qualified Registered Nurse to join our clinical review team. You will assess medical records, determine coverage eligibility, and ensure documentation aligns with payer requirements.

This on-site role offers Monday–Friday daytime hours and requires strong attention to detail, excellent communication, and independent work across departments. As an RN with Medicare/Medicaid knowledge, you will evaluate diagnoses and orders, escalate complex