Utilization Review RN - Remote, Mon-Fri, No Nights

Hines Associates Ltd.; United States; Remote; USD 57,000 - 62,000; Full time

Benefits offered by this job

Remote setting

Medical, dental, vision benefits

Job summary

Hines & Associates is seeking registered nurses for a Monday–Friday role focused on clinical decision reviews to determine eligibility for outpatient or inpatient services. This position emphasizes URAC guidelines, disability and workers compensation regulations, and collaboration with case managers.

Experience in mental health or substance abuse is required; 3+ years of acute care practice is preferred. A remote setting is offered within a nationwide team, with a salary- and benefit-rich

Qualifications

• RN license (US) in the relevant state
• Mental health or substance abuse experience
• UR nurse orientation completion
• Minimum 3 years acute clinical practice; 5 years preferred
• Managed care, disability or workers comp experience helpful but not mandatory
• Customer service orientation

Responsibilities

• Reviews patient status and certifications for outpatient or inpatient services
• Certifies treatment when criteria are met per health plan regulations
• Collaborates with case managers and disease management nurses
• Maintains knowledge of URAC guidelines and relevant procedures
• Performs onsite evaluations as needed
• Handles additional responsibilities as assigned

Skills

Empathy

Communication

Teamwork

Education

RN license (US)

Mental Health / Substance Abuse experience

Tools

URAC guidelines

Job description

Hines & Associates is seeking registered nurses for a Monday–Friday role focused on clinical decision reviews to determine eligibility for outpatient or inpatient services. This position emphasizes URAC guidelines, disability and workers compensation regulations, and collaboration with case managers.

Experience in mental health or substance abuse is required; 3+ years of acute care practice is preferred. A remote setting is offered within a nationwide team, with a salary- and benefit-rich