Remote RN Utilization Management

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This range is provided by The Judge Group. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$35.00/hr - $37.00/hr

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Pay Rate: $36-37/hr

Start Date: April 7th

Licenses required: Compact AND California AND DC

Job Summary: We are seeking experienced Registered Nurses (RNs) for a remote temp-to-perm opportunity. The RN will be responsible for completing quality audits of physician case reviews, supporting the clinical aspects of the review process, and resolving operational issues. This role requires a high level of technical skills and the ability to work with multiple programs concurrently.

Responsibilities:

• Complete quality audits of physician case reviews using national medical guidelines (MCG, Interqual, etc.), evaluating the clinical aspects of cases and auditing for accuracy and completeness.
• Format reviews in accordance with specific formatting requirements.
• Support the clinical aspects of the review process.
• Resolve operational issues related to the clinical aspects of review cases.
• Communicate with assigned reviewers and treating/ordering practitioners/providers.
• Advise and provide guidance to reviewers on the operational aspects of review cases in all categories (i.e., standard, and ERO cases).
• Collaborate with the Chief Medical Director and Director of Provider Relations to address reviewer quality issues and support the Provider Relations assessment process.
• Maintain or exceed the established monthly production benchmark.

Qualifications:

• Must have a compact/multistate license AND a CA single state AND a DC single state.
• Minimum 3 years of RN experience in a clinical setting with a preference for a broad scope of practice.
• Hospital bedside nursing experience in ICU, ER, Med/Surg, or Dialysis is required. Backgrounds limited to OR, Peds, L&D, Women’s services, etc., are not preferred.
• No travel RNs unless they have a stable work history (3+ years at the same facility) either prior to or after their travel assignments.
• No NPs, whether practicing or not.
• Utilization Review experience is helpful but not required; critical thinking skills are more important.
• Proficiency with computers is essential. Candidates will use three monitors (laptop and 2 additional screens) and multiple web-based systems with multiple passwords, as well as Teams, Outlook, and some data entry in Excel.
• Experience with Milliman or Interqual is a plus.
• Candidates should not need any extended time off during the first three months of training (approximately 2 months).

Schedule:

• Monday – Friday, 8:00 AM – 4:30 PM MT, with rotating weekends (approximately one weekend every 6 weeks). Comp days will be provided during the week when working the weekend.

Additional Information:

• Equipment will be provided.

Not Applicable

Full-time

Health Care Provider and Administrative

Business Consulting and Services and Hospitals and Health Care