Utilization Review Nurse - LPN (Remote)

Morgan Stephens; Atlanta (GA); Remote; USD 80,000 - 92,000; Full time

Job summary

An established industry player is seeking a Utilization Management Nurse to join their remote team. In this vital role, you will ensure patients navigate their care journey smoothly while adhering to regulatory standards. You will conduct reviews, manage a diverse workload, and collaborate with care teams to enhance patient outcomes. This position offers a full benefits package and the opportunity to work in a dynamic environment focused on patient-centered care. If you are passionate about healthcare and looking to make a difference, this role is perfect for you.

Benefits

Full benefit package with employer contribution

Qualifications

• Current PN Nurse license is required.
• 2 years of Utilization Management experience is essential.

Responsibilities

• Conduct Utilization Management reviews, ensuring accurate data tracking.
• Collaborate with multi-disciplinary teams to improve processes.

Skills

Utilization Review

Patient Care Coordination

Regulatory Compliance

Data Tracking and Reporting

Education

Associate's Degree

Job description

Job Summary:

As a Utilization Management Nurse, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses. Proficient in Utilization Review processes, you'll maintain effective procedures to meet regulatory and reimbursement requirements for various payers, both commercial and government.

100% Remote - However, Only candidates on EST Time Zone are considered.

Key Responsibilities:

• Conduct concurrent and continued stay Utilization Management reviews, ensuring accurate data tracking, evaluation, and reporting.
• Lead or participate actively in process improvement initiatives, collaborating with various departments and multi-disciplinary teams.
• Efficiently manage a diverse workload in a fast-paced, ever-evolving regulatory environment.
• Foster positive collaboration with the Care team to facilitate timely patient progression during their stay.

Job Requirements:

• Current PN Nurse license
• Associate's degree preferred.
• 2 years of Utilization Management experience in large health organization.
• Hospital case management experience is advantageous.
• Proficiency in federal and state regulations (DOH, Medicaid/Medicare) and familiarity with third-party payers and managed care principles.

Salary Range: $80,000+
Benefits: Full benefit package available with employer contribution.

Join our dynamic team and be part of our commitment to efficient Utilization Management and patient-focused care.