UM RN

The Judge Group; United States; Remote; USD 60,000 - 80,000; Full time

Job summary

An established industry player is seeking skilled Remote Utilization Review RNs to join their dynamic team. In this ongoing contract role, you will leverage your nursing expertise and tech-savviness to conduct case reviews and ensure compliance with national medical guidelines. This position offers a unique opportunity to work remotely while engaging with various healthcare professionals and systems. If you are passionate about quality healthcare and possess the necessary licenses, this could be the perfect opportunity for you to make a significant impact in the healthcare sector.

Qualifications

• 3+ years of RN experience in a clinical setting with a broad scope of practice.
• Must possess a CA RN license plus at least one or two more state licenses.

Responsibilities

• Conduct quality audits of physician case reviews adhering to national medical guidelines.
• Collaborate with medical directors to address reviewer quality issues.

Skills

Clinical Nursing

Quality Auditing

Computer Skills

Communication Skills

Education

Registered Nurse License

Compact/Multistate RN License

Tools

Microsoft Teams

Microsoft Outlook

Excel

Job description

Direct message the job poster from The Judge Group

Judge Healthcare is currently seeking 2 Remote Utilization Review RN's for one of biggest clients!

*MUST POSSESS A CA RN LICENSE PLUS AT LEAST ONE OR TWO MORE OTHER STATE LICENSES*

Type: Ongoing Contract (W2, Weekly Pay)

Hours: Monday – Friday 8AM-4:30PM MST, rotating weekends, approximately one weekend every 6 weeks. Comp day(s) to be provided during the week that you work the weekend.

Job Overview: We are seeking a highly skilled and tech-savvy Registered Nurse to join our team. In this role, you will work within client systems to complete case reviews and input information into our tracking systems. You will utilize multiple programs concurrently throughout your workday.

Responsibilities:

• Conduct quality audits of physician case reviews, adhering to national medical guidelines (e.g., MCG, InterQual) and evaluating the clinical aspects for accuracy and completeness.
• Format reviews according to specific formatting requirements.
• Support the clinical aspects of the review process.
• Resolve operational issues related to the clinical aspects of review cases.
• Communicate with assigned reviewers and treating/ordering practitioners/providers.
• Advise and guide reviewers on the operational aspects of review cases, including standard and ERO cases.
• Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues and support the Provider Relations assessment process.
• Maintain or exceed the established monthly production benchmark.

Requirements:

• Possess a compact/multistate RN license AND at least 2 single state RN licenses, including one from California.
• Minimum of 3 years of RN experience in a clinical setting with a broad scope of practice.
• Previous hospital bedside nursing experience in ICU, ER, M/S, or Dialysis settings (excluding OR, Peds, L&D, Women’s services, etc.).
• Strong computer skills: ability to use three monitors (laptop and 2 additional screens), multiple web-based systems with various passwords, Teams, Outlook, and some data entry in Excel.
• Experience with Milliman or InterQual is a plus.

Seniority level

Mid-Senior level

Employment type

Contract

Job function

Health Care Provider

Industries

Health and Human Services and Hospitals and Health Care