Utilization Review Nurse

Ampcus Incorporated; Phoenix (AZ); Remote; USD 75,000 - 95,000; Full time

Job summary

A leading technology consulting firm seeks a motivated Utilization Review Nurse to join their team. This remote position requires an unrestricted RN license and involves conducting UM clinical reviews, utilizing Interqual criteria, and ensuring adherence to standards like HIPAA. Ideal candidates will have 2-3 years of nursing experience and strong critical thinking abilities.

Qualifications

• 2-3 years of experience in a clinical nursing role.
• Experience utilizing Interqual criteria.
• Strict adherence to HIPAA.

Responsibilities

• Conduct UM Clinical Review Acute IP Initial & CSR reviews.
• Handle adhoc UM responsibilities related to Clinical review process.

Skills

Critical thinking

Clinical judgment

Problem-solving

Education

Unrestricted RN License

Tools

Interqual criteria

Microsoft Excel

Microsoft TEAMS

Microsoft Outlook

Job description

Bravens Inc., a wholly owned subsidiary of Ampcus Inc., is an information technology consulting and services company. Bravens is a leader in providing tailored staffing solutions across both IT and non-IT industries. We are in search of a highly motivated candidate to join our talented team and contribute to our ongoing success.

Location(s): Remote

Job Title: Utilization Review Nurse

Job Description / Responsibilities:

• UM Clinical Review Acute IP Initial & CSR reviews
• Adhoc UM responsibilities related to Clinical review process

Top 3 Skills Must Have:

• Unrestricted RN License (REQUIRED)
• Utilization Review experience
• Experience utilizing Interqual criteria

Experience: 2-3 years

Required Skills:

• Current Active and Unrestricted Registered Nursing License required
• Experience utilizing Interqual medical necessity criteria resource tool
• Familiar with NCQA and CMS Guidelines
• Strict adherence to HIPAA
• Excellent critical thinking, clinical judgment, and problem-solving skills

Preferred Skills:

• Knowledgeable with Microsoft products including Excel, TEAMS, Outlook
• Familiar with ICD-10 diagnosis codes / CPT codes
• Strong verbal and written communication skills

Bravens is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veterans, or individuals with disabilities.