- Workplace
- Remote
- Type
- Full-time
- Experience
- 2+ years
- Education
- Master
- Source
- RecruiterFlow
Description
Quick Job Details:
Setting: Fully Remote – Utilization Review
Schedule: Full-Time, Monday–Friday
Hours: Standard business hours
Patient Volume: N/A
Job Requirements:
- Active RN license with Multi-State/Compact license required
- Minimum 2 years of Utilization Review experience
- Minimum 3 years of clinical nursing experience (acute care/hospital preferred)
- Strong understanding of medical necessity, utilization management, healthcare reimbursement, and clinical documentation improvement
- Excellent communication, analytical, and critical thinking skills
- Ability to work independently in a remote environment
Responsibilities:
- Conduct admission, continued stay, and observation reviews
- Apply medical necessity criteria to determine appropriate level of care
- Review cases for Physician Advisor escalation when appropriate
- Collaborate with physicians, case managers, and insurance payers
- Support denial prevention, documentation improvement, and revenue cycle initiatives
- Ensure compliance with payer guidelines and regulatory requirements
- Analyze clinical and financial data to identify quality improvement opportunities
Compensation: Competitive; based on experience
Benefits: Comprehensive benefits package
About Us:
HealthPlus Staffing is a national leader in the healthcare staffing industry. We partner with top healthcare organizations nationwide to connect highly qualified professionals with outstanding career opportunities.
Our Promise:
- We will put you in front of the decision makers.
- We will provide feedback on your application.
- We will work on your behalf to obtain as much information as possible to help you make a well-informed decision.
If you're interested in this opportunity, please submit an application or call 561-291-7787 to speak with one of our experienced consultants. We look forward to helping you find your next opportunity!
The HealthPlus Team
Skills
Compliance
