Do you want to work for a company that Forbes named one of the Top 50 Most Innovative Companies? Are you looking to fast-track your career with one of LinkedIn's top companies in the U.S.? If so, keep reading!

Title of Job: Remote Utilization Review Nurse

Location: REMOTE (anywhere in the US)

CSI Companies is hiring a Remote Utilization Review Nurse for our Fortune 100 healthcare client in Minnetonka, MN. This job can be worked from anywhere in the US as long as you have high speed internet and a distraction-free home office area.

Job Summary
The Remote Utilization Review Nurse is primarily responsible for conducting retrospective medical necessity reviews for inpatient and outpatient services, ensuring compliance with established medical criteria and supporting reimbursement processes.

Pay: $35.25 – 42.25 an hour based on experience.
Hours: Full Time - Monday-Friday 8am-5pm EST

Why this Opportunity?

Top ranked company in Fortune’s “World’s Most Admired Companies” 14 years in a row.
This healthcare client is ranked number one in key attributes of reputation:
- Innovation
- People management
- Social responsibility
- Quality of Management
- Financial soundness
- Long-term investment value
- Quality of products
- Services and global competitiveness

Status: Long Term Consultant. Long term consultant, no end date, with good job stability. There is always potential for conversion to FTE status with the client for the right employee upon business needs. Almost all of the positions within this client start off as a consultant due to being a Fortune 100 company.
Effective Date / Tentative Start Date: Interviewing Immediately

Job Duties:

Conduct retrospective clinical reviews based on state and medical necessity criteria using InterQual guidelines
Apply critical thinking and adhere to documented processes to support clinical appellate reviews
Meet department standards for productivity and quality, ensuring timely review of assigned cases per payor guidelines
Perform follow-up on initial denials received from payors on retrospective clinical reviews by first level of appeal submission
Validate that Diagnosis and Procedure codes align with services performed, escalating discrepancies as needed
Maintain compliance with HIPAA regulations and ensure confidentiality of medical records

Requirements

High school diploma or equivalent
Active, unrestricted RN or LVN license in state of residency
Completion of an accredited Registered Nurse or Licensed Vocational Nurse program
Minimum 3 years of clinical practice experience
Minimum 2 years of utilization management and/or case management experience
A reliable high-speed internet connection (the faster the better!)
Ability to pass a background check and drug test
Private, quiet, and distraction-free workspace in a room with a closed-door

Highly Preferred

Large corporation experience
Health plan / managed care / healthcare industry experience
Bachelor's degree in Nursing or a related healthcare field

WHO SHOULD APPLY?
If you have experience in Retrospective Review, Utilization Review, case management, Appeals & Denials, InterQual, First-Level Appeal Submissions, or Medical Claims Review, we would love for you to apply!

Apply to become part of the team that is not only changing people’s lives for the better but changing the health care system for the next generations to come.

About Us
The CSI Companies is a recruiting firm established in 1994 that has been awarded “Best of Staffing” for 8 years in a row. We provide outstanding services to the world’s leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration. Only those candidates identified for an interview will be contacted.
Benefits Offered:

Weekly pay
Medical, dental, and vision coverage
Voluntary Life and AD&D coverage
Paid Training
Opportunity for advancement upon performance and availability

APPLY NOW and a recruiter will be in touch with you to schedule a phone screening!
#VMSUL

The CSI Companies

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Remote Utilization Review Nurse