Our client is a well-established top leading utilization company continuously growing and now has need for additional Contract-to-Direct Hire full-time RN Clinical Quality Auditors for their Utilization Management Team and Quality Management (Case Management) Team to work collaboratively with Physicians as medical review & quality assurance professionals assisting with the review of chronic diseases & oncology patients. Qualified candidates will be self-directed, assertive, and creative in problem-solving, as well as a keen eye for detail. RNs are able to work anywhere within the US.

Schedule: 5, 8-hour shifts each week between the hours 7am to7:00pm Mountain time. The schedule includes 1 weekend every 6 weeks in addition to your late shift during the week, a weekend rotation of 1 weekend every 6 weeks and 1 late Friday every 4 weeks.

Must Have Requirements:

1. Compact State RN License with 2 or more additional non-compact single state licenses required

2. Bachelor or Associate of Science in Nursing, required

3. 3+ years of acute care RN experience, ideally ICU/ED/Med-Surg

Major Responsibilities or Assigned Duties:

Complete quality audits of individual case reviews.

Support the clinical aspects of the review process and case reviews, including but not limited to:

Support the reviewer selection and assignment process.

Resolve operational issues arising in connection with the clinical aspects of review cases.

Communicate with assigned reviewers and with treating/ordering practitioners/providers.

Evaluate the clinical aspects of a review case.

Support the Case Fulfillment process and provide education to analysts as appropriate.

Advise and provide guidance to reviewers on the operational aspects of review cases in all categories (i.e., standard, and ERO cases) and provide them with information pertinent to their assigned cases and related review processes.

Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues; support the Provider Relations assessment process.

Maintain or exceed the established monthly production benchmark.

Support all Quality Management initiatives including the complaint process.

Support all Compliance Program activities.

Keep up to date on clinical knowledge through continuing education opportunities.

Job Types: Full-time, Contract

Pay: $35.00 per hour

Benefits:

401(k)
Dental insurance
Health insurance
Paid time off
Vision insurance

Medical Specialty:

Critical & Intensive Care
Medical-Surgical

Experience:

inpatient acute care: 3 years (Required)

License/Certification:

Compact State Nurse License (Required)
Two Non-Compact State Nurse License (Required)

Shift availability:

Day Shift (Required)
Night Shift (Required)

Work Location: Remote

LevelUP HCS jobs

Utilization Management Nurse