Utilization Review Nurse at Rising Medical Solutions | Torre

Utilization Review Nurse

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Full-time

Legal agreement: Employment

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Remote (for United States residents)
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Emma of Torre.ai
4 months ago

Responsibilities


Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!**This is a full-time position - 40 hours per week (Must work M-F each day).ResponsibilitiesPerform all aspects of the Utilization Review ProcessReview records and requests for UR, which may arrive via mail, e-mail, fax, or phoneUtilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician ReviewWrite nurse summaries on all UR filesDocument properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UREstablish collaborative relationships with clients, patients, employers, providers and attorneysTrack ongoing status of all UR activity so that appropriate turn-around times are metMaintain organized files containing clinical documentation of interactions with all parties of every claimUtilize good clinical judgment, careful listening, and critical thinking and assessment skillsRespond to various written and telephonic inquiries regarding status of caseMust be proficient in the use of a computer, including the use of various software programs simultaneouslyRequirementsAn Associate's or Bachelor's degree in NursingHold an active and unencumbered RN license in one or more states 3 to 5 years of clinical practice experience or 2 years of case management and/or UR experienceMore than one state license (a plus)Experience with Workers' Compensation, short-term or long-term disability, or liability claimsThe ability to set priorities and work both autonomously and as a team memberWell-developed time-management, organization, and prioritization skills Excellent analytical skills Superb oral and written communicationThe ability to gather data, compile information, and prepare summary reports Strong interpersonal and conflict resolution skills Experience in a fast-paced, multi-faceted environmentDemonstrated persistence and attention to detail General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines Working knowledge of: Microsoft Word, Excel, and Outlook Ability to remain calm during stressful situations A customer-service mindsetBenefitsGenerous Flexible Time Off (take it when you need it!)Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matchingCareer Growth Opportunities - We often promote from withinProfessional Development Reimbursement Program (PDRP)You will be part of our new Elevate program designed to recognize and reward employees for their hard workRising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions | Top WorkplacesWe're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical Want to see more? Check out our:Facebook: https://www.facebook.com/RisingMedicalSolutions LinkedIn: http://www.linkedin.com/company/rising-medical-sol.. If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!