Utilization Review Nurse -- Remote

Date Posted: 04/05/2021

Equity Staffing is searching for several Remote Utilization Review Nurses . This position is with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!


Position Description:
Collect case specific member information, review and certify the medical necessity of prospective, concurrent, and retrospective units of inpatient and outpatient services.
Review each case and determine the most appropriate services, the most appropriate setting in which the services should be delivered, the most cost efficient methods for care of delivery, and the need for planning subsequent care for contracted members and their eligible dependents as assigned.
Providing clinical and managed care expertise, as well as Medical Director/Physician consultation.
Provide first level clinical review for all inpatient and outpatient services requiring authorization for assigned client groups regarding: Prospective Review Urgent/Non-urgent, Concurrent Review, Retrospective Review, Early initiation of discharge coordination, Analyze case-specific patient information.
Verify eligibility, as applicable, and past utilization history. Client-specific protocol and procedures.
Maximize referrals to network providers.
Evaluation for referral to case management. Focused Second Surgical Opinion Review. Identifying and reporting quality of care issues.
Answer telephone calls promptly as scheduled and as needed.
Maintain working knowledge of all client groups.
Demonstrate adequate competence in computer software use in daily activities.
Review case-specific patient information concurrently for the medical necessity of hospital admissions using commercial review criteria and/or scripted guidelines.
Based on severity or complexity of the enrollee’s condition, ability to meet commercial review criteria and or scripted guidelines, the necessary treatment, and the discharge planning activity (not routinely conducted on a daily basis), the nurse reviewer will assign the appropriate LOS days/visits/services in review of the clinical information obtained.
Document pertinent clinical information regarding individual reviews in SOAP format.
Ensure timely notification of all parties (telephonic and/or written), as necessary, regarding certification recommendations.
Assist in administering the second surgical opinion process.

Qualifications include:
Active LPN nurse licensure; minimum of 1 year clinical experience in an acute care setting.
Previous Utilization Management experience preferred.
Sound clinical judgment, Demonstrated understanding of managed care concepts, Strong problem solving and decision making skills, Strong departmental team player.
Good written and verbal communication skills, Personal computer skills, Strong time management and prioritization skills.
Excellent customer service skills including a sense of urgency and ownership for resolving issues.
Strong interpersonal skills at an individual and team level.
Ability to be flexible, adjust quickly and react positively to change.
Knowledge of ICD-9 and CPT coding preferred.
Considerable knowledge of principles, practices and current trends in nursing.
Positive attitude and good work ethics.

Equity Staffing Group is one of the fastest growing Native American owned staffing companies in the United States. We are a certified Minority Business Enterprise (MBE) by the National Minority Supplier Development Council (NMSDC) and the Rocky Mountain Minority Supplier Development Council (RMMSDC).

Equity Staffing Group is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Equity Staffing Group will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.
We welcome you to learn more about our company by visiting www.equitystaffing.com.
Equity Staffing Native American owned staffing companies in the United States. We are a certified Minority Business Enterprise (MBE) by the National Minority Supplier Development Council (NMSDC) and the Rocky Mountain Minority Supplier Development Council (RMMSDC).

Equity Staffing Group is an Equal Employment Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law. Equity Staffing Group will consider qualified applicants with criminal histories in a manner consistent with the requirements of applicable law.

We welcome you to learn more about our company by visiting www.equitystaffing.com


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Testimonials

"I was so impressed with the outstanding service that Equity Staffing provided in placing me in my current position.  I wasn’t sure I would be a good candidate for this position, but my recruiter and Equity’s Account Manager took the time to go over the job description and how my experience and skill set would fit in perfectly with this job assignment.  I am glad I took their advice, because I am now on contract with a great company working with a professional staff and learning how to support a management team in an industry I have never worked in before.” 

Lisa M.

Denver, CO

“I’ve been an IT contractor for 9 years, and in that time I’ve been exposed to numerous IT staffing firms and consulting agencies, big and small.  Equity impressed me immediately.  My recruiters quickly and efficiently connected me with a great tech company whose needs in both personality and tech proficiency matched my wheelhouse in addition to a healthy dose of career progressing tech challenges.  And a 12 minute drive from my house no less.  That’s huge for me.  They were willing to meet face to face before the client company interview which, in my experience, is critical to the staffing firm / contractor relationship.  Equity is organized, modern, and professional, and my recruiters were very pleasant to work with, responsive, and generous with their time.  I’m grateful for all they’ve done for me.”

Christopher S.

Minneapolis, MN

“Working as a consultant for Equity Staffing Group has been a wonderful experience.  My recruiter was a true professional throughout the entire process.  Equity separates itself from other staffing companies I have worked with in past because they provided wonderful customer service, they had benefits offerings,  the onboarding was easy and efficient but best of all they followed up with me prior to my assignment ending and found my next assignment shortly afterward.  I highly recommend the professionals at Equity Staffing Group!”

Tamika B.

Atlanta, GA

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