Virtual Utilization Review Specialist Jobs

The Utilization Review Specialist will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Specialist will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Specialist will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria.

• 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

• Bachelor’s Degree
• Must have a current Registered Nurse license
• 2 years of recent hospital-based Utilization Review 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 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. Hiring day shift: 8am-4pm and night shift 4pm-12am. Also, must be able to work 4 weekend days a month.

For this US-based position, the base pay range is $65,500.00 - $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%.

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.

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