We’re actively seeking a qualified Registered Nurse with experience in utilization review to join our team! This is a part-time, fully remote role for Saturdays from 9am to 5pm. As a Utilization Management RN, you’ll be responsible for conducting telephonic reviews of hospital admissions, recommending alternative levels of care, and supporting efficient, high-quality healthcare delivery. Your efforts will directly contribute to timely discharge planning, ensuring patients receive the most appropriate care in the most suitable setting.
Key Responsibilities:
- Conduct telephonic utilization management for inpatient admissions
- Review treatment plans and assess the medical need for continued inpatient care
- Collaborate with physicians, hospital case management, and families to facilitate early discharge planning
- Identify cases that no longer meet criteria and refer to Medical Directors for evaluation
- Document and maintain accurate information in compliance with state, federal, and accreditation standards
- Provide exceptional customer service and support to all providers involved in patient care
- Identify quality of care issues and work with the Quality Management team to resolve them
Required Skills & Experience:
- Registered Nurse (BSN preferred)
- At least 3 years of acute care clinical experience in a hospital or healthcare setting
- Previous discharge planning and/or utilization management experience required
- Exceptional communication and problem-solving abilities
- Proficiency with InterQual
- Strong organizational and team management skills
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