Remote | Part-time
Physician Advisory Services – Utilization Review Specialist – Registered Nurse
- Remote USA
- United States
- R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals and physician practices.
- Headquartered in Chicago, R1 is publicly-traded organization with employees throughout the US and international locations.
- 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.
- The successful candidate must have hospital-based Utilization Review or Case Management experience.
- Perform initial admission and continued stay reviews utilizing InterQual and Milliman using evidenced-based criteria in order 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
- Must be a current Registered Nurse
- 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 is required
- Must be willing to work a variable schedule that encompasses evenings, days, weekends and holidays Coverage Hours: 8:00AM-12:00AM CST (9:00AM-1:00AM EST)
- Required: Associates or better.
- Bachelors or better.
- Required: 2-3 years inpatient UR experience