Saint Luke's seeks a Remote Utilization Review RN to join our team. In this role, you will be responsible for assuring high quality, cost efficient medical outcomes through utilization review and management. You'll collaborate with physicians, Care Coordinators, Social Workers, and other team members as part of our faith-based, nonprofit, locally owned health system committed to excellence in patient care.
What You'll Do
- Complete initial and concurrent reviews; identify appropriate level of service and length of stay using clinical guidelines.
- Comply with CMS regulations regarding utilization review and management.
- Obtain and manage insurance authorizations and proactively work denials to help mitigate financial impact.
- Submit referrals for secondary level review as appropriate and follow through on process.
- Document communication and work in the electronic medical record.
- Work with physicians and members of the multidisciplinary and revenue cycle teams to ensure appropriate level of service, level of care, and billing.
What We're Looking For
- A current Registered Nurse license.
- An Associate Degree.
- Less than 1 year of applicable experience.
Technical Stack
- InterQual clinical guidelines
- Electronic medical record system
Team & Environment
You will be a member of multidisciplinary and revenue cycle teams, collaborating closely to support patient care.
Work Mode
This is a fully remote position open to candidates within the United States of America.
Saint Luke's is an Equal Opportunity Employer.
