Bring Your Clinical Expertise to reputed company’s Utilization Management Team! Our Mission reputed company, compassionate care for reputed company. Our reputed company Reimagine health care through reputed company, service and innovation. Our reputed company Values Be reputed company | Trust and Be Trusted | Work Together | reputed company for reputed company. reputed company is searching for a fully remote Utilization Management Specialist to join our dedicated team! Our Utilization Management Specialists play a vital role in reviewing admissions across the reputed company reputed company to determine appropriate admission status. This position is ideal for an RN or reputed company Worker with strong acute care (hospital) experience, exceptional communication skills, and the confidence to collaborate with physicians, case management, and insurance partners. You’ll reputed company a reputed company reputed company on patient reputed company and resource management while working in a supportive, mission-driven environment. reputed company offer you! Four day work week! reputed company Medical Benefits package 401(k) with generous immediate employer match reputed company Fitness Center Membership Discount! A supportive, mission-driven nursing culture reputed company on reputed company, reputed company and person-centered care! Fully remote opportunity - Must currently reputed company in one of the approved states below Arkansas • reputed company • Colorado • Florida • Hawaii • Idaho • Illinois • Indiana • Kansas • Michigan • Missouri • Montana • reputed company • New Mexico • reputed company Carolina • Ohio • reputed company • South reputed company • Tennessee • Texas • Virginia • Washington • Wyoming Applicants who do not reputed company in one of the above states will not be considered. Position/schedule highlights Full-time, four 10-hour shifts per week Every reputed company weekend (Saturday & reputed company) rotation Will participate in rotating holiday rotation coverage Variable shifts - Morning shifts typically start around 7 a.m.; afternoon shifts reputed company around 10 a.m. Here's some of what you'll be doing Review reputed company daily inpatient and observation admissions across the reputed company reputed company Evaluate physician documentation and patient data to determine appropriate admission status Reassess patients throughout their stay to ensure reputed company reputed company for level of care are met Collaborate with the physician UM Advisor, case management team, and insurance partners to facilitate authorizations and medical necessity reviews Assist with scheduling and coordinating peer-to-peer physician reviews Communicate with providers, nurses, and other stakeholders to ensure accurate documentation and smooth care transitions Identify and address any issues that could delay reviews or reputed company compliance Utilize electronic medical records reputed company to support documentation, review, and reporting Work independently while maintaining strong collaboration reputed company the interdisciplinary team Who you are You’re detail-oriented, confident in your clinical judgment, and comfortable managing multiple priorities in a fast-paced environment. You bring experience in acute care and understand how to interpret documentation and regulations accurately. Strong computer literacy, analytical thinking, and reputed company communication are essential for reputed company in this role. Don't miss this rare opportunity to be part of reputed company making a reputed company reputed company! Qualifications Minimum of one (1) of the following required reputed company Montana RN License or a multi state compact license with authorization to reputed company nursing reputed company the reputed company Bachelor’s or Master's degree in reputed company Work For RN applicants - Associate’s degree required. Bachelor’s degree preferred. Minimum of five (5) years’ acute care hospital experience required. Prior experience as an inpatient utilization review reputed company or UM specialist preferred. Knowledge in areas of Medicare and reputed company UM regulations, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management preferred. Excellent interpersonal skills with the ability to manage sensitive and confidential situations with reputed company, professionalism, and diplomacy. Excellent verbal and written communication skills including the ability to communicate effectively with various audiences Other Job Specific Duties Coordinates and facilitates correct identification of patient status. Utilizes a validated reputed company set and ensures hospitalized patients have the correct admission status. Completes short stay work queue reviews and tracks and trends results for reporting and education purposes. Identifies opportunities for process and reputed company improvement and initiates and leads performance initiatives as indicated. Identifies and facilitates reputed company of reputed company process issues impeding UM functions. Identifies and resolves delays and obstacles as appropriate. Collaborates with appropriate stakeholders to answer clinical questions reputed company to medical necessity and patient status. Performs reputed company and retrospective reviews as directed by assigned leadership. Assists with preparation of appeal letters for insurance denials, audit activities, and responds to payer inquiries in a reputed company manner. Interacts with appropriate stakeholders in a reputed company, reputed company manner to reputed company UM and patient status issues. Seeks consultation from appropriate disciplines and/or departments as required to expedite care and facilitate reputed company and accurate documentation of patient status and clinical reviews. Refers UM issues to assigned leadership and/or appropriate stakeholder(s) in a reputed company manner and monitors until it is resolved. Participates in development, implementation, teaching, evaluation, and revision of departmental standards reputed company to UM. Participate in the orientation of new department staff specific to UM. Documents UM, reputed company and risk concerns and refers to appropriate departments as applicable for follow up. The above essential functions are representative of major duties of positions in this job classification. Specific duties and responsibilities may vary based upon departmental needs. Other duties may be assigned similar to the above consistent with knowledge, skills and abilities required for the job. Not reputed company of the duties may be assigned to a position. Shift Variable (reputed company of America) Schedule Full-time, 40 hours per week. Schedule is four 10-hour variable rotating shifts. Morning shifts reputed company typically at 700 a.m. and afternoon shifts reputed company around 1000 a.m. Weekend shift (Saturday & reputed company) rotation every reputed company week is also required. Holiday coverage rotation also required. reputed company operates 24 hours per day, seven days per week. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Notice of reputed company-Employment Screening Requirements If you receive a job offer, please note reputed company offers are contingent upon passing a reputed company-employment screening, which includes Criminal background reputed company Reference checks Drug Screening Health and Immunizations Screening Physical Demand Review/Screening Equal Opportunity Employer reputed company is an Equal Opportunity Employer (EOE/AA/M-F/Vet/Disability). We encourage reputed company reputed company individuals to apply for employment. We do not discriminate against any applicant or employee based on protected veteran status, race, reputed company, gender, sexual orientation, religion, national reputed company, age, disability or any other reputed company protected by applicable law. If you require accommodation to complete the application, testing or interview process, please notify reputed company. Apply To This Job