EG - Utilization Review Nurse - Remote

Remote Registered Nurse (RN) - Prior Authorization and Inpatient Utilization Management (Medicare Advantage)

Position Type: Remote, Contract

Pay Range: $36 - $42 per hour, Depending on Experience (DOE)

Job Overview

We are seeking a highly skilled Registered Nurse (RN) licensed in Ohio for a remote project. You Must have an active, unrestricted OHIO RN license, but you can live outside of OHIO. This position focuses on Prior Authorization and Inpatient Utilization Management with a primary emphasis on Medicare Advantage Determinations. The ideal candidate will have experience in prior authorization, inpatient and post-acute care settings, and Medicare operations.

Key Responsibilities

• Prior Authorization & Determinations: Process prior authorization requests and make determinations for Medicare Advantage cases.
• Inpatient Utilization Management: Conduct inpatient concurrent reviews and manage Medicare Advantage inpatient determinations, including acute and post-acute care cases.
• Medicare Advantage Appeals: Evaluate and make determinations on Medicare Advantage appeals, covering both inpatient and outpatient cases.
• Case Management: Effectively handle a caseload of 12-14 cases per day, ensuring thorough and accurate reviews.
• Documentation: Maintain detailed, accurate records and documentation for each case, following organizational and regulatory standards.
  
  

Qualifications

• RN License: Active, unrestricted RN license in the state of Ohio.
• Experience: Minimum of 2 years of experience in prior authorization and Medicare operations, with specific expertise in Medicare Advantage and inpatient utilization management.
• Technical Proficiency: Comfortable with telecommuting tools and electronic health record (EHR) systems for remote case management.
• Attention to Detail: Strong analytical skills and ability to review cases meticulously, making informed determinations.
  
  

Why Join Us?

This is a remote opportunity offering flexibility and a competitive hourly rate, allowing you to apply your expertise in prior authorization and Medicare Advantage determinations from the comfort of your home. If you are passionate about utilization management and making a difference in healthcare outcomes, we encourage you to apply!

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