Utilization Review RN — Flexible PTO & Career Growth

Rising Medical Solutions, LLC

United States

Remote

USD 75,000 - 105,000

Full time

13 days ago

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Benefits offered by this job

Flexible Time Off

Health/Dental/Vision Insurance

401k Matching

Career Growth Opportunities

Job summary

Rising Medical Solutions, LLC is seeking a Utilization Review Nurse to perform comprehensive UR activities and nurse summaries. The role requires an active RN license and clinical or UR/case management experience.

You will document, review records, and collaborate with clients and providers to ensure appropriate authorization decisions. The position is full-time (40 hours/week, M-F) and emphasizes accuracy, time management, and strong analytical skills in a fast-paced, healthcare-cost

Qualifications

Active and unencumbered RN license in one or more states.
3–5 years of clinical practice experience or 2 years of case management/UR experience.
Experience with Workers' Compensation, short-term/long-term disability, or liability claims.
Strong analytical and communication skills.

Responsibilities

Perform all aspects of the Utilization Review Process
Review records and requests for UR via mail, email, fax, or phone
Utilize evidence-based guidelines to determine authorization vs. peer/physician review
Write nurse summaries on all UR files
Document in Rising's database and client databases; send determination letters
Establish collaborative relationships with clients, patients, employers, providers and attorneys
Track status of UR activity to meet turnaround times
Maintain organized files with clinical documentation
Use good clinical judgment, listening, and assessment skills
Respond to inquiries regarding case status
Proficient in computer use and multiple software programs