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UR Clinical Specialist (Remote)
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Job Description
- Req#: 300000726682697
Employer Industry: Healthcare Services
Why consider this job opportunity:
- Opportunity for career advancement and growth within the organization
- Competitive salary based on experience
- Comprehensive benefits package including health, dental, and retirement plans
- Supportive and collaborative work environment
- Chance to make a positive impact on patient care and resource optimization
- Engaging in training initiatives and professional development opportunities
What to Expect (Job Responsibilities):
- Perform admission and continued stay reviews using evidence-based criteria and regulatory guidelines
- Collaborate with physicians and clinical teams to obtain necessary documentation for medical necessity
- Document all utilization review activities in the hospital's case management software
- Communicate effectively with utilization review coordinators and case managers to ensure a collaborative approach
- Analyze trends in hospital admissions and extended stays to identify opportunities for process improvements
What is Required (Qualifications):
- Associate Degree in Nursing required
- 2-4 years of clinical experience in utilization review, case management, or acute care nursing required
- RN - Registered Nurse - State Licensure and/or Compact State Licensure required
- Strong knowledge of utilization management principles and regulatory requirements
- Proficiency in case management software and electronic health records (EHR)
How to Stand Out (Preferred Qualifications):
- Bachelor's Degree in Nursing preferred
- 1-3 years work experience in care management preferred
- 1-2 years of experience in utilization management, payer relations, or hospital revenue cycle preferred
- CCM - Certified Case Manager preferred or Accredited Case Manager (ACM) preferred
#HealthcareServices #ClinicalReview #PatientCare #CareerOpportunity #NursingJobs
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