Job Description

Position:Utilization Review Nurse

Location:  100% Remote

Duration:8 Week Contract, with possibility of extension

Start Date: ASAP

Job Description:

The Utilization Review Author 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. Upon identification of a case, the Utilization Review Author will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. The successful candidate must have hospital-based Utilization Review or Case Management experience.

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

Minimum Qualifications:

·Must have a current Registered Nurse license

·At least 2 years of recent hospital-based Utilization or Case Management Experience

·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 required 

·Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays

Medasource is an equal opportunity employer that does not discriminate on the basis of actual or perceived race, color, creed, religion, national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth, lactation and related medical conditions), gender identity or gender expression, sexual orientation, marital status, military service and veteran status, physical or mental disability, protected medical condition as defined by applicable state or local law, genetic information, or any other characteristic protected by applicable federal, state, or local laws and ordinances.

Benefits & Perks:

Medasource offers competitive medical, dental, vision, Health Savings Account, Dependent Care FSA, and supplemental coverage with plans that can fit each employee’s needs. We offer a 401k plan that includes a company match and is fully vested after you become eligible, paid time off, sick time, and paid company holidays. We also offer an Employee Assistance Program (EAP) that provides services like virtual counseling, financial services, legal services, life coaching, etc.

Pay Disclaimer:

The pay range for this job level is a general guideline only and not a guarantee of compensation or salary. Additional factors considered in extending an offer include (but are not limited to) responsibilities of the job, education, experience, knowledge, skills, and abilities, as well as internal equity, alignment with market data, applicable bargaining agreement (if any), or other law.

JO-2507-174103

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