Job Title: Utilization Review Nurse (RN/LPN)

Department: Medical Management

Reports To: Manager

Budget Responsibility: None

Level of Authority: Staff Position

We are looking for an experienced part-time Utilization Review Nurse. In this position, you will be responsible for ensuring efficient and cost-effective use of healthcare resources while maintaining high-quality patient care standards and support. Your expertise in utilization management will be instrumental in making evidence-based decisions and optimizing patient outcomes.

Independent Clinics of Washington (ICW) is an alliance of local healthcare providers dedicated to offering Medicaid and Medicare patients high-quality, individualized care, while helping independent practices stay independent. ICW helps local providers build their practices and care for their patients by managing administrative tasks, negotiating rates with plans, cutting red tape for faster claims processing, minimizing authorization requirements, advocating for patients, connecting local providers in a supportive network, and more.

We strive to build an inclusive, supportive work culture and are looking for a new teammate who excels as a collaborator and will contribute to the positive environment.

Key Responsibilities

Conduct pre-certification of inpatient and outpatient services to ensure compliance with medical policy, member benefits, and contracts
Utilize evidence-based clinical guidelines to make utilization management decisions.
Proactively identify at-risk patients in need of case/disease management programs
Meet delivery timelines in notifying patients and providers of authorization decisions.
Collaborate with healthcare teams to facilitate continuity of care and optimal patient outcomes.
Verify all enrollment/eligibility benefits prior to authorizing treatment.
Maintain accurate documentation of utilization and case management activities.
Adheres to ICW’s policies and procedures, including compliance with HIPAA privacy and security requirements and all state, federal and plan regulatory mandates.
Participate in quality improvement initiatives to enhance processes and service delivery.

Required Knowledge, Skills, and Abilities

Strong verbal and written communication skills
Ability to work independently, initiate, and successfully complete tasks with minimal supervision.
Cultural awareness
Problem-solving aptitude and the ability to navigate challenging situations with sensitivity and professionalism
Excellent analytical and critical thinking skills for decision-making and problem-solving
Familiar with the application of Interqual criteria
Confidence in learning new software platforms

Basic Qualification

Unrestricted Washington State RN or LPN license required
Three (3) years of experience in utilization management

Preferred Qualifications

Previous experience working with a managed care program
Bilingual

As part of the Medical Management ICW team you will receive:

Competitive salary and comprehensive benefit package
Opportunities for professional growth
Work-life balance with flexible scheduling options
Fully remote position

Equipment Requirements
Requires use of personal computer compatible with Microsoft Remote Desktop with two monitors, microphone, and camera.

Note

The statements herein are intended to describe the general nature and level of work being performed by employees in this position and are not to be construed as an exhaustive list of responsibilities, duties and skills required of personnel so classified. Furthermore, they do not establish a contract for employment and are subject to change at the discretion of the employer.

Job Type: Part-time

Pay: $43.00 - $54.00 per hour

Expected hours: 20 – 24 per week

Benefits:

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

Schedule:

Day shift
Monday to Friday

Experience:

Utilization review: 3 years (Required)

License/Certification:

Washington State or compact RN or LPN (Required)

Location:

Washington State (Required)

Work Location: Remote

Independent Clinics of Washington jobs

Utilization Review Nurse (RN/LPN)