Utilization Review Nurse

Insight Global; North Carolina; Remote; USD 70,000 - 90,000; Full time

Job summary

A leading staffing agency is looking for a Utilization Review Registered Nurse to work remotely with a major health insurance client. This role involves evaluating patient care cases and ensuring requested services align with medical necessity while adhering to confidentiality policies. The ideal candidate has over 2 years of experience in utilization review and significant clinical experience in an acute setting. Strong written and verbal communication skills are essential.

Qualifications

• Minimum 2 years of Utilization Review experience on the payer side.
• At least 5 years of clinical experience in an acute environment.
• 1+ year experience with MCG and InterQual tooling.

Responsibilities

• Evaluate patient care cases per hour for inpatient and outpatient.
• Assess patient care requests for medical services.
• Collaborate with providers to ensure medical necessity.

Skills

Utilization Review experience

Clinical experience in acute environment

Proficiency in Google Suite Applications

Attention to detail

Flexibility

Written and verbal communication

Education

Associate Degree or Bachelor's Degree in Nursing

Tools

MCG and InterQual tooling

MacBook proficiency

Job description

Insight Global is looking for a Utilization Review Registered Nurse to sit remotely with one of their large health insurance clients. This person will be responsible for evaluating 3.5 patient care cases per hour (both inpatient and outpatient) and collaborating with doctors, and other healthcare professionals. Day to day this individual will be assessing patient care requests for medical services and collaborating with providers to ensure the requested services align with medical necessity. It is critical that this person adheres to company policies regarding confidentiality and privacy. This person needs to pay very close attention to detail, be a team player, have flexibility in their day to day, etc. Being an expert within the plan and benefit template is crucial, and having great written and verbal communication is important!

Must Haves

• 2+ years of experience in Utilization Review experience on the payer side for both inpatient and outpatient cases
• 5+ years of clinical experience in an acute environment (not behavioral health)
• 1+ year MCG and InterQual tooling experience
• Reside in the following: ALABAMA ARIZONA COLORADO CONNECTICUT DISTRICT OF COLUMBIA FLORIDA GEORGIA ILLINOIS IOWA KANSAS KENTUCKY MAINE MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSOURI NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA OHIO OREGON PENNSYLVANIA RHODE ISLAND SOUTH CAROLINA TENNESSEE TEXAS UTAH VERMONT VIRGINIA WASHINGTON
• Registered Nurse
• Proficiency using a MacBook
• Proficiency in Google Suite Applications (google sheets, calendar, etc.)
• Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing

Plusses

• Compact license
• Experience working in the ED or in Critical Care