Description

American Traveler is hiring a Utilization Management RN for a fully remote role requiring 2 years of acute care UM experience and a TX or compact RN license.

Details

• Fully remote position within a centralized Utilization Management department
• Centralized acute admission utilization review across 13 acute care and critical access hospitals
• Shift hours are 08:30-17:00
• Uses Cerner with Careport (Allscripts) EMR system
• 13-week assignment length

Requirements

• Active RN license (TX or Compact) required
• BLS certification (AHA) required
• Minimum 2 years acute care Utilization Management experience or equivalent required
• Proficiency with InterQual/MCG and CMS regulations required
• Experience with payor portals, managed Medicare/Medicaid insurers, and Google Workspace preferred
• Remote work experience preferred
• Nursys license verification required within 30 days prior to start

Additional Information

• Review admissions and service requests for prospective, concurrent, and retrospective medical necessity and reimbursement policy compliance
• Provide case management and consultation for complex cases
• Assist staff with coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals issues
• Assess and coordinate discharge planning needs with healthcare team members
• Prepare statistical analysis and utilization review reports as needed
• Oversee and coordinate compliance with federally mandated and third-party payer UM rules and regulations
• Requires critical thinking, decisive judgment, and ability to work independently in a fast-paced environment
• Local candidates accepted at a reduced rate under facility radius rule
• First-time travelers may be considered