Utilization Review Nurse - RN, LPN, or LCSW (Remote)

Morgan Stephens; Reno (NV); Remote; USD 80,000 - 92,000; Full time

Job summary

Join a leading healthcare organization in a fully remote position as a Utilization Management Nurse/Social Worker. You'll ensure patients progress smoothly through their care journey while meeting regulatory requirements. This role demands a current Nevada license and experience in acute hospital care and utilization management.

Benefits

Full benefit package available with employer contribution

Qualifications

• Current Nurse license or Clinical License in Nevada required.
• 3-5 years of acute hospital experience required.
• 3 years of Utilization Management experience in large health organization required.

Responsibilities

• Conduct Utilization Management reviews, ensuring accurate data tracking and evaluation.
• Lead or participate in process improvement initiatives.
• Foster positive collaboration with the Care team for timely patient progression.

Skills

Utilization Review processes

Concurrent and continued stay reviews

Federal and state regulations

Collaboration

Education

Associate's degree

Bachelor's degree (preferred)

Job description

Job Summary:

As a Utilization Management Nurse/Social Worker, 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 Nevada Licenses 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 Nurse license or Clinical License in Nevada.
• Associate's degree; Bachelor's degree preferred.
• 3-5 years of acute hospital experience and 3 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: Yes- 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.

Date of Original Job Posting: 12/10/24