Job Title: Review Nurse

Job Description

The Review Nurse will be responsible for reviewing approximately 20 cases a day to assess medical necessity for members admitted to the hospital. The primary goal is to advocate for and protect members from unnecessary hospital admissions. This role requires following various procedures and processes to complete authorizations successfully. The nurse will collaborate with a team of nurses and communicate with doctors and case managers to make informed decisions and gather additional information about the member’s condition.

Responsibilities

• Review approximately 20 cases a day for medical necessity.
• Advocate for and protect members from unnecessary hospital admissions.
• Follow established procedures and processes to complete authorizations.
• Collaborate with a team of nurses to assist each other and complete cases.
• Communicate with doctors and case managers to make decisions and obtain additional information about members' conditions.
• Utilize multiple resources to ensure the successful completion of cases.

Essential Skills

• Experience in utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning.
• Proficiency with InterQual.
• Active Compact RN License.
• Utilization Management/Concurrent Review experience.
• ICU/ER experience.
• Strong communication skills.
• Strong computer/documentation skills.

Work Environment

This is a full remote work-from-home position. The hours are Monday through Friday from 8:00am to 5:00pm. The dress code is business casual. T