Remote | Part-time
R1

Physician Advisory Services – Utilization Review Specialist – Registered Nurse

  • Part-Time
  • Remote USA
  • United States

Description:

  • 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.

Responsibilities:

  • 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

Required Qualifications:

  • 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)

Qualifications

Education:

  • Required: Associates or better.
  • Bachelors or better.

Experience

  • Required: 2-3 years inpatient UR experience