RN Utilization Review Remote
Utilization Review RN
HealthCare Support is actively seeking a Utilization Review RN to fill an opening with a Prestigious HealthCare Company in Remote Houston TX.
Daily Responsibilities for Utilization Review RN:
WIll need to use their OWN EQUIPMENT: 2 screens, will need a headset, high speed internet, (Chromebooks do not work well but MAC or any other seem to work fine)
1. Review telephonic and faxed clinical information to authorize medically necessary inpatient and outpatient care, utilizing nationally recognized evidenced based clinical criteria or approved medical guidelines. Refers cases that do not meet criteria to Medical Director for review.
2. Assists in discharge planning especially Home Health Nursing requests and DME requests for members at the time of discharge as well as new requests for members who have not had recent hospitalization. Review any requests for extension of these services and if not meeting criteria, refer to the Medical Director.
3. Participates in Community Nursing Rounds if applicable with Medical Director and is adequately prepared. Assists co-workers with difficult cases through open discussion. Communicates concerns that arise in these discussions to the Manager and/or Medical Director.
4. Maintains knowledge of the designated referral and provider software systems. Verifies member eligibility, benefit coverage and facility contract status prior to processing authorization requests. Accurately enters the required information into the managed care platform, adhering to UM policies and procedures.
5. Assists in the coordination of care of hospitalized members, medically complex members and members with special needs if applicable. Makes appropriate referrals and follow up to other Community programs/departments.
6. Meets required performance metrics for cases reviewed within established turnaround times. Meets established quality standards
7. Actively contributes to achievement of departmental goals, as identified in Department’s annual business plan, including specific departmental process improvement plans.
8. Demonstrates Harris Health and Community Health Choice values, including trust, integrity, mutual respect, diversity, responsiveness and caring service.
Shifts
- Weekends Thurs-Sun 10 hr days 7 am to 5pm
- Mon-Fri 8-5.
Required Qualifications for Utilization Review RN:
- RN, current Texas License
- Three years clinical experience in acute setting. 3 years of UR/UM
- Highlight lines of business worked- Texas Medicaid, CHIP, marketplace
- Highlight experience – was it inpatient or outpatient
- Microsoft Office (Word, Outlook, Excel)
Preferred Qualifications for Utilization Review RN:
- Interqual Experience is preferred
- Caseloads will be 20-25 per day for Nurses
Benefits for Utilization Review RN:
- Immediate enrollment in Health Insurance
- Dental Insurance
- Life Insurance
- Employee Assistance Program (EAP)
- Access to Investment Accounts
- Career and educational tools within our Ingenovis ACT (Advocacy) Program
Pay Details: $38 – $42 /Hour
Interested in being considered?
If you are interested in applying to this position, please click Apply Now for immediate consideration.
For additional consideration, please email a copy of your resume to Grace.Acarino@healthcaresupport.com with your phone number, the job title and location, and our recruiters will reach out.
Healthcare Support Staffing, LLC. is an equal employment opportunity employer and will consider all qualified applicants without regard to race, color, religion, disability, sex, sexual orientation, gender identity, national origin, protected veteran status, or any other characteristic protected by applicable local, state, or federal law.