Registered Nurse-Utilization Review
3B Healthcare, Inc.
Registered Nurse Utilization Review (Remote)
Position Overview: 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).
Required Qualifications:
- 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 612 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)
Vacancy posted 3 days ago
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