Registered Nurse-Utilization Review

Job description

Registered Nurse – Utilization Review (Remote) This is a fully remote Utilization Review RN role supporting multiple service lines and levels of care, including Inpatient, Extended Hospital Outpatient, and Observation (OBS). Minimum of 3 years acute medical Care Management/Utilization Review experience in a hospital setting (experience in health plans or medical groups is not applicable). InterQual experience is mandatory; candidates without this will not be considered. Proficient in Epic, with recent use within the last 6–12 months. Experience working with HMOs, IPAs, and similar managed care organizations. Strong knowledge of Medicare regulations and associated utilization management processes, including: • Condition Code 44 (CC44) • Advance Beneficiary Notices (ABNs) • Hospital-Issued Notices of Noncoverage (HINNs) • Medicare Coverage Status Notices (MCSNs)