Utilization Review Nurse (Remote)

About the Role

Emergency Medicine position at Martin's Point Health Care in Remote. Join a team focused on quality patient care with excellent work-life balance.

Work-Life Balance Factors

Remote/telehealth

⚠️ Fast-paced environment

Key Responsibilities

• Manage the review of medical claims disputes, records, and authorizations for billing, coding, and other compliance or reimbursement related issues
• Coordinates referrals to Care Management, as appropriate.
• May be responsible for maintaining a caseload for concurrent cases/ assisting in caseload coverage for the team
• Establishes and maintains strong professional relationships with community providers.
• Proficiency in conducting prospective, concurrent, and retrospective reviews using standardized criteria and guidelines like MCG
• Ability to manage multiple demands.

Requirements

• Education/Experience
• Associate's degree in nursing
• Bachelor's degree in nursing preferred
• Licensure/certification
• Compact RN license
• 3+ years of clinical nursing experience as an RN, preferably in a hospital setting

Benefits & Compensation

• Join Martin's Point Health Care
• taking care of ourselves and others, continuous learning, helping each other, and having fun
• Employees are expected to work consistently to demonstrate the mission, vision, and core values of the organization.
• Participates as a member of an interdisciplinary team in the Health Management Department
• Participates in the review and analysis of population data and metrics to inform development of programs and improved health outcomes.
• 2+ years Utilization Management experience in a health plan UM department

Work Schedule

• Responsible for weekend coverage on a rotating basis.
• Technically savvy and can navigate multiple systems and screens while working cases