CORTEX IS LOOKING FOR A REMOTE UTILIZATION REVIEW RN  TO MATCH WITH A FANTASTIC JOB!

Salary: $85,000 per year

QUALIFICATIONS

Current Nevada RN License 

Located near Las Vegas & able to meet in the office on occasion, but do most work remote

RN Bachelor's (Required)

Utilization review: 1 year (Required)

Clinical nursing experience (2-4 years)

Experience in care or utilization management (2+ years)

JOB DESCRIPTION

Utilization Review Nurse Duties and Responsibilities

· Review new referral emails and make a decision on acceptance (within one hour of receiving a referral), if declining, provide explanation via email.

· Balance quality of care with cost efficiency

· Compile and review medical information and insurance coverage (example: PHCN)

· Authorize requested medical services

· Refer to quickpdgm.com for estimated revenue for Medicare/Medicare advantage plans

· Identify alternative, cost-effective resources

· Monitor staff utilization in regards to visit allowance assigned and staff compliance to the assigned visits.

· Calculate visit limits for each discipline based off of quickpdgm.com analysis, and inform field staff of the visit limits for each 30-day window in the cert period.

· Maintain UR excel spreadsheet to track the following for patients as they are accepted:

· 1"8/2"d 30-day period date ranges

· 1"&2" 30-day period visit allowance vs actual visits completed

· LUPA days

· Assigned disciplines

· Estimated vs actual revenue

· Monitor staff documentation to ensure continued appropriateness of visits and address staff as needed.

· One week of admin on call per month Monday-Sunday.

CORTEX is looking for a Utilization Review RN  that is: Reliable Dedicated A Team Player

Join us! In addition to applying, we invite you to copy & paste the link below to become a member of the Cortex RN Community, a community and job board exclusively for Registered Nurses. The Cortex RN Community is determined to find you a fantastic job, be it at Cortex or with one of our fabulous partners.

Join us in the Cortex RN Community

https://rn.cortexhc.com/community-registration 

CORTEX'S RECRUITING MANAGER WILL TEXT YOU SHORTLY AFTER APPLYING! 

WE LOOK FORWARD TO HELPING YOU FIND A GREAT JOB!