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New

RN Utilization Review – Remote

Cortex

This is a Contract position in Boulder City, NV posted November 23, 2021.

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!

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