What are the responsibilities and job description for the Remote Utilization Review Nurse position at CSI Companies?
Job Summary
The Remote Utilization Review Nurse is primarily responsible for conducting retrospective medical necessity reviews for inpatient and outpatient services, ensuring compliance with established medical criteria and supporting reimbursement processes.
Pay : $35.25 – 42.25 an hour based on experience.
Hours : Full Time - Monday-Friday 8am-5pm EST
Why this Opportunity?
Top ranked company in Fortune’s “World’s Most Admired Companies” 14 years in a row.
This healthcare client is ranked number one in key attributes of reputation : Innovation People management Social responsibility Quality of Management Financial soundness Long-term investment value Quality of products Services and global competitiveness
Status : Long Term Consultant. Long term consultant, no end date, with good job stability. There is always potential for conversion to FTE status with the client for the right employee upon business needs. Almost all of the positions within this client start off as a consultant due to being a Fortune 100 company.
Effective Date / Tentative Start Date : Interviewing Immediately
Job Duties :
Conduct retrospective clinical reviews based on state and medical necessity criteria using InterQual guidelines
Apply critical thinking and adhere to documented processes to support clinical appellate reviews
Meet department standards for productivity and quality, ensuring timely review of assigned cases per payor guidelines
Perform follow-up on initial denials received from payors on retrospective clinical reviews by first level of appeal submission
Validate that Diagnosis and Procedure codes align with services performed, escalating discrepancies as needed
Maintain compliance with HIPAA regulations and ensure confidentiality of medical records
Requirements
High school diploma or equivalent
Active, unrestricted RN or LVN license in state of residency
Completion of an accredited Registered Nurse or Licensed Vocational Nurse program
Minimum 3 years of clinical practice experience
Minimum 2 years of utilization management and / or case management experience
A reliable high-speed internet connection (the faster the better)
Ability to pass a background check and drug test
Private, quiet, and distraction-free workspace in a room with a closed-door
Highly Preferred
Large corporation experience
Health plan / managed care / healthcare industry experience
Bachelor's degree in Nursing or a related healthcare field
Benefits Offered :
Weekly pay
Medical, dental, and vision coverage
Voluntary Life and AD&D coverage
Paid Training
Opportunity for advancement upon performance and availability
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