Utilization Review (UR) Author - RN Required

R1 RCM; Tennessee; Hybrid; USD 65,000 - 97,000; Full time

Job summary

R1 RCM is seeking an experienced Utilization Review Author (RN) for our Physician Advisory Team. The role involves first-level admission and continued stay reviews using InterQual/MCG criteria and requires hospital-based UR or Case Management experience.

The position offers a flexible schedule with some weekend work and a target annual bonus. Candidates must hold an active RN license and a Bachelor's degree, with strong analytical and communication skills.

Qualifications

• Must have a current Registered Nurse license in your state of residence.
• Bachelor’s Degree is required.
• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred.
• At least 3 years of clinical nursing experience (practice).
• Knowledge of current Medicare rules and regulations related to Utilization Review.
• Strong analytical, organizational and time management skills.
• Ability to work independently with limited supervision.
• Excellent written and verbal communication skills.
• Excellent clinical abstraction and attention to detail.
• Experience with InterQual and/or MCG is preferred.
• Must be willing to work a variable schedule including evenings, days, weekends, and holidays (7:00 AM-12:00 AM EST).

Responsibilities

• Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria.
• Abstract data from medical records to ensure accurate clinical data.
• Adhere to established quality, timeliness, and productivity outputs for first-level nursing utilization review.
• Ensure effective communication internally and externally while delivering excellent customer service.
• Participate in system testing, training and other opportunities that promote growth.
• Complete and maintain annual compliance and annual HIPAA training.
• Participate in organizational educational offerings and required training as needed.

Skills

Analytical skills

Organizational skills

Time management

Written and verbal communication

Independent work

Attention to detail

Education

Bachelor’s Degree

Tools

InterQual

MCG

Job description

Remote, USA

Remote, GA

Remote, MS

Remote, NC

Remote, TN

Remote, AR

Remote, FL

Remote, KY

Remote, AL

Remote, IN

Full time

R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry's most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration.

As our Utilization Review Author (UR Author) - RN Required , you will be part of our Physician Advisory Team providing first-level initial admission and continued stay case reviews. The Utilization Review Author will determine the appropriate cases for review, utilizing client-specific guidelines. After identifying a case, the Utilization Review Author will ensure appropriate orders and clinical documentation are in place before applying the evidence-based criteria. The successful candidate will have hospital-based Utilization Review or Case Management experience.

*Flexible Schedule with some weekend requirements throughout the month

Responsibilities:

• Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care

• Abstract data from a variety of medical records to ensure accurate clinical data

• Adhere to established quality, timeliness, and productivity outputs required in the completion of first-level nursing utilization review

• Ensure effective communication internally and externally while delivering excellent customer service

• Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals, which may include system testing, training, and other opportunities that promote growth

• Complete and maintain annual compliance and annual HIPAA training

• Participate in organizational educational offerings and required training as needed to support service delivery

Required Qualifications:

• Must have a current Registered Nurse license in your state of residence

• Bachelor’s Degree

• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred

• At least 3 years of clinical nursing experience (practice)

• Knowledge of current Medicare rules and regulations related to Utilization Review

• Strong analytical, organizational and time management skills

• Ability to work independently with limited supervision

• Excellent written and verbal communication skills

• Excellent clinical abstraction and attention to detail

• Experience with InterQual and/or MCG is preferred

• Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays (Coverage Hours: 7:00 AM-12:00 AM EST)

For this US-based position, the base pay range is $65,478.00 - $96,885.29 per year . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%

The healthcare system is always evolving - and it's up to us to use our shared expertise to find new solutions that can keep up. On our growing team you'll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team - including offering a competitive benefits package. (http://go.r1rcm.com/benefits)

R1 RCM Inc. ("the Company") is dedicated to the fundamentals of equal employment opportunity. The Company's employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person's age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent (https://f.hubspotusercontent20.net/hubfs/4941928/California%20Consent%20Notice.pdf)

To learn more, visit: R1RCM.com

Visit us on Facebook (https://www.facebook.com/R1RCM)

R1 is the leader in healthcare revenue management, helping providers achieve new levels of performance through smart orchestration. A pioneer in the industry, R1 created the first Healthcare Revenue Operating System: a modular, intelligent platform that integrates automation, AI, and human expertise to strengthen the entire revenue cycle. With more than 20 years of experience, R1 partners with 1,000 providers, including 95 of the top 100 U.S. health systems, and handles over 270 million payer transactions annually. This scale provides unmatched operational insight to help healthcare organizations unlock greater long-term value. To learn more, visit: https://www.r1rcm.com .