Responsibilities

• Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care
• Abstract data from a variety of medical records to ensure accurate clinical data
• Adhere to established quality, timeliness, and productivity outputs required in the completion of first-level nursing utilization review
• Ensure effective communication internally and externally while delivering excellent customer service
• Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals, which may include system testing, training, and other opportunities that promote growth
• Complete and maintain annual compliance and annual HIPAA training
• Participate in organizational educational offerings and required training as needed to support service delivery

Required Qualifications

• Must have a current Registered Nurse license in your state of residence
• Bachelor's Degree
• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred
• At least 3 years of clinical nursing experience (practice)
• Knowledge of current Medicare rules and regulations related to Utilization Review
• Strong analytical, organizational and time management skills
• Ability to work independently with limited supervision
• Excellent written and verbal communication skills
• Excellent clinical abstraction and attention to detail
• Experience with InterQual and/or MCG is preferred
• Must be willing to work a variable schedule that encompasses evenings, days, weekends, and holidays (Coverage Hours: 7:00 AM-12:00 AM EST)

For this US-based position, the base pay range is $65,478.00 - $96,885.29 per year. Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

This job is eligible to participate in our annual bonus plan at a target of 10.00%