Utilization Review Nurse
Protouch Staffing
Key Responsibilities
- Review patient medical records to determine the medical necessity and appropriateness of admissions, continued stays, and services.
- Perform concurrent and retrospective utilization reviews in accordance with established clinical guidelines.
- Collaborate with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and ensure efficient resource utilization.
- Document review findings accurately using Epic and Dragonfly utilization management software.
- Ensure compliance with payer requirements, regulatory standards, and organizational policies.
- Identify potential barriers to discharge and communicate recommendations to the care team.
- Maintain accurate documentation and participate in quality improvement initiatives.
- Active Registered Nurse (RN) license.
- Minimum 2 years of Utilization Management/Utilization Review experience required.
- BLS Certification required.
- CCM (Certified Case Manager) or CMCN (Certified Managed Care Nurse) certification required.
- Experience with Epic EMR and Dragonfly utilization management tool preferred.
- Prior travel nursing experience highly preferred.
- Comfortable working independently in a remote environment and proficient with computer systems.
- Candidate must provide their own computer/workstation (equipment is not supplied).
- Degree accreditation verification required, or 5 years of relevant experience in lieu of degree verification.
- Must successfully complete the HWL prescreen interview followed by the facility manager interview.
- 100% Remote opportunity-work from the comfort of your home.
- Consistent Monday-Friday day shift schedule with excellent work-life balance.
- Join a collaborative team using industry-leading technology like Epic and Dragonfly.
- Gain valuable experience in Utilization Management with a respected healthcare organization.
- Streamlined hiring process with prescreening, manager interview, and quick offers for qualified candidates.
- Excellent opportunity for experienced UR/Case Management nurses seeking long-term remote career growth.
Vacancy posted more than 2 months ago
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