Utilization Management RN Part-Time Remote Position

HealthCare Strategies; United States; Remote; USD 36,000 - 57,000; Part time

Job summary

HealthCare Strategies is seeking an Utilization Management RN to handle telephonic assessments and medical necessity reviews from a home office. The role supports plan members, educates patients, and determines prior authorization needs during core hours.

Requirements include an active RN license and hospital experience. Strong communication, problem-solving, and MS Office proficiency are needed to document outcomes and coordinate with providers.

Qualifications

• Active, unrestricted RN Compact License.
• Minimum 1+ year experience in hospital setting.
• Strong verbal communication and ability to follow instructions.

Responsibilities

• Perform telephonic Clinical Assessments.
• Obtain information from provider/patient regarding plan.
• Interpret criteria to support inpatient/outpatient service decisions.
• Document calls completely and accurately in the system.

Skills

Strong verbal communication

Problem solving

Decision making

MS Office

Education

RN license

Tools

Outlook

Word

Job description

Utilization Management RN (M-F FROM YOUR HOME OFFICE)

HealthCare Strategies

Description

Do you want to work from the comfort of your own HOME? Do you want to work for a progressive company that is a leader in their industry?

P/T 20 to 25 hours/week

Monday - Friday

Hours: 9am - 6pm ET (core office hours)

JOB DESCRIPTION

• Responsible for the collection of personal and clinical information on participating Plan members for the purpose of:


• Providing patient education services.


• Rendering initial determinations of medical appropriateness for communication to the health benefit plan.


• Identifying individuals whose health and/or expenses may be positively affected through application of Large Case Management.

SPECIFICS

• Perform telephonic Clinical Assessments


• Obtain appropriate information from health care provider and or patient or family regarding planned procedure, admission, continued stay or discharge plan.


• Interpret nationally recognized criteria to support recommendations for inpatient and outpatient services.


• Identify and refer individuals whose health and/or expenses may be positively affected through the application of Case Management.


• Document each call completely, accurately and promptly into the computer system.


• Follow documented policies and procedures for the handling of confidential materials and/or patient specific information.


• Answer direct telephone calls related to medical services in order to determine if prior authorization is required for the requested services.


• Retrieve and acknowledge messages requesting medical services from voicemail.


• Complete all medical necessity reviews and communicate outcomes to providers within the appropriate time frames.


• Provide educational materials and direct callers to community services when indicated.


• Provide coverage for professional colleagues.

REQUIREMENTS

• Active, unrestricted RN Compact License


• Minimum internet speeds of 25Mbps download; 25 Mbps upload


• 1+ years experience in hospital setting

ABILITIES/SKILLS

• Strong verbal communication skills


• Problem-solving and decision-making skills


• Ability to carry out detailed written or verbal instructions independently


• Proficiency with Microsoft Office Suite (Outlook, Word)

PREFERRED

• 1+ years previous UM experience


• Experience using Interqual criteria.

During our over 40 years in business, HealthCare Strategies has earned a reputation for delivering quality services as a medical management provider and now through technology platforms by offering next generation, informatics-driven, health management services used singularly, or in tandem, with our highly effective clinical programs.