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Remote RN Utilization Review
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RADIXSOL SOLUTIONS (OPC) PRIVATE LIMITED
Remote
$101,920 Salary, Full-Time
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Job Description
Remote RN Utilization Review
RADIXSOL SOLUTIONS
(OPC)PRIVATE LIMITED
- 4.3 Apple Valley, CA Job Details Contract $1,880
- $2,040 a week 6 hours ago Benefits Health insurance Qualifications Medicare Utilization review RN License CMS Employment & labor law Acute care facility experience CMS regulatory compliance Medicare regulations InterQual Utilization management Resource utilization in healthcare Medicaid regulations Acute care
Nursing Full Job Description Job Title:
Registered Nurse (RN)Utilization Review Schedule:
Day Shift | 5x8-Hour | 8:00 AM- 4:30 PM We are seeking an experienced Remote Registered Nurse (RN)
- Utilization Review with a strong background in acute care case management and utilization management within a hospital setting.
Requirements:
Active RN License Minimum 3 years of acute care Care Management/Utilization Review experience in a hospital setting Experience performing utilization reviews, concurrent reviews, and medical necessity determinations Strong knowledge of InterQual Criteria Experience with Medicare, Medi-Cal, and CMS regulations Excellent communication and documentation skillsResponsibilities:
Perform utilization review activities to ensure appropriate level of care and resource utilization Conduct concurrent, continued stay, pre-certification, retrospective, and admission reviews Evaluate medical necessity using InterQual criteria and payer guidelines Manage appeals and denials and collaborate with payers regarding authorization requests Review patient records for compliance with regulatory and reimbursement requirements Work closely with physicians, case managers, and interdisciplinary teams to support optimal patient outcomes Ensure compliance with CMS, HIPAA, Joint Commission, and other regulatory standards RN01Job Type:
Contract Pay:
$1,880.00- $2,040.