CASE MANAGER / REGISTERED NURSE / RN
Troy, OH · On-site
$65 - $90/hr
New
Troy, OH · On-site
$65 - $90/hr
New
Columbus, OH · On-site
$55K - $110K/yr
Dublin, OH · On-site
$85 - $105/hr
New
Columbus, OH · On-site
$65 - $90/hr
New
Columbus, OH · On-site
$65 - $90/hr
Chillicothe, OH · On-site
$90 - $130/hr
Columbus, OH · On-site
$65 - $90/hr
Logan, OH · On-site
$75 - $113/hr
New
Columbus, OH · On-site
$300K/yr
Columbus, OH · On-site
$300K/yr
Columbus, OH · On-site
$300K/yr
Chillicothe, OH · On-site
$36.27 - $54.41/hr
Columbus, OH · On-site
$300K/yr
Logan, OH · On-site
$36.27 - $54.41/hr
Logan, OH · On-site
$36.27 - $54.41/hr
Columbus, OH · On-site
$56K - $75K/yr
Columbus, OH · On-site
$90 - $130/hr
New
The qualifications to become a remote utilization management nurse include graduating from an approved nursing program, holding a current, unrestricted RN license, and having 3 years of direct patient care or managed care experience. In a hospital, the RNs who fill this role often have their BSN as well. Those who work in a nursing home or primary care environments may or may not be required to have a BSN, depending on the protocol of the facility. In general, you need excellent interpersonal and organizational skills. You also must be able to properly evaluate and advise on hospital admission, imaging studies, referrals, length of stay, medications, surgeries, and other procedures and treatments. Because you work from home, having a reliable internet connection and a dedicated phone line is essential.
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Salary range: $69,500 - $101,000
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As a remote utilization nurse, your duties are to work from home or a remote location to review patient medical records and prepare a range of paperwork for different types of actions a hospital or health care provider can take. Your responsibilities are to determine patient coverage, carry out denial of service authorizations, and negotiate different treatment options and hospital stay length for patients. You rely on your knowledge of treatment options and diseases to determine the level of appropriate care for a patient. Because you telecommute, you also need good technical skills.
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A utilization review nurse determines the best course of treatment for a patient using preapproved policy criteria. Utilization review nurses collect and review patient records, clinical documentation, and billing information to recommend the best use of patient care resources. Their assessments help determine the length of hospital stays, the effectiveness of the care plan, and the necessity of the services administered. Utilization review nurses inform and educate patients about their options based on their insurance benefits and limitations. Utilization review nurses also assess patient care services in clinical appeals for approval or denial.