Travel RN - Case Management​/Utilization Review - Utilization Review

Location: Fernbank

American Traveler is seeking an experienced RN for a remote Utilization Management position requiring strong utilization review and Epic EMR experience.

Job Details

• Work setting is fully remote,

• Focus on Utilization Management for health plan members in acute care and rehabilitation settings,

• Day shifts, Monday through Friday, 8:00 AM to 5:00 PM EST,

• No direct patient care is involved, strictly medical review responsibilities,

• Uses Epic EMR and referral platforms like Navi Health or AllScripts,

• Application of Inter Qual and/or Milliman criteria software systems to determine service authorizations,

Job Requirements

• Active RN license (MD or compact),

• Minimum 5 years of RN experience required,

• Current utilization review experience required,

• At least 1 year of managed care utilization review experience preferred,

• Experience with Epic EMR, Navi Health or AllScripts, and Inter Qual and/or Milliman criteria required,

• Experience in facilities with 500+ bed count required,

Additional Information

• Responsible for daily management and review of care for health plan members in acute and rehabilitative settings,

• Collaborate with Medical Directors to determine service authorizations and initiate discharge planning,

• Communicate authorizations and denials to providers, facilities, and plan members both verbally and in writing,

• Maintain clinical knowledge and meet documentation and quality standards,

• Strong verbal, written, and interpersonal communication skills required,

• Computer proficiency and ability to work with multiple online systems is essential,

• Must be able to negotiate and resolve conflicts with external customers,

• Locals are eligible except for Howard County General where a 60-mile radius rule applies,