Job Description:

Location: REMOTE

Salary: $38.00 USD Hourly - $38.46 USD Hourly

Description: Our client is currently seeking a REMOTE UM RN!




Job Details: Temp to Hire (W2, Weekly Pay, Benefits Available)

Location: *REMOTE*



Hours: Monday-Friday (40 hours/week; 8/day - can be flexible)


Compensation: $38.46/hour



Position Summary: The Physician Advisory Team offers a range of services that help navigate the path to compliant revenue. The Payor Peer to Peer team reviews cases for which the authorization has been denied evaluating if the proper documentation was available to support the admission status, procedure, and care setting that was requested. The Nurse Author in Payor Peer to Peer advises our clients regarding the appropriateness of the request based on available documentation. Our goal is to assist our client facilities in ensuring proper billing and authorization level; thereby increasing clean claims submission and reducing accounts receivable days. This team can also serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.


This job will have the following responsibilities:

• Writing client-facing clinical consultations evaluating the authorization requested, documentation support or lack of support for that authorization, evidenced based criteria for that support, and complex clinical evaluation of the request as a whole


• Evaluation and interpretation of multiple types of hospital documentation as it relates to the requested authorization, including but not limited to emergency department documentation, history and physical, progress notes, interpretation of lab and imaging results, vital sign trends, physical and occupational therapy notes, and medication administration records.


• Provide strength evaluation and recommendations to clients using a combination of understanding of commercially available criteria and clinical judgement for establishing medical necessity arguments in the setting of concurrent denials


• Nurses should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment.


• Successful nurses will meet or exceed minimum productivity and quality standards.


• Provide feedback regarding actionable root cause analysis of the specific case to customer to utilization review team and/or case managers at client hospitals regarding submitted case determinations.


• Provide written analysis of the case and perform case reviews across multiple specialties

Qualifications & Requirements:

• Prior UM exp
  
  


• Prior InterQual and MCG experience
  
  


• Proficient computer skills (including, but not limited to, spreadsheets, Internet, and email) are required.
  
  


• Active, current registered nurse license in at least one US state
  
  


• At least 3 years of acute, hospital-based clinical experience in a medical/surgical unit, emergency department, and/or ICU
  
  


• Home office that is HIPAA compliant
  
  


• BSN required
  
  

All qualified and interested candidates, please send your most updated resumes to
edemey@judge.com
for immediate consideration!



Contact: edemey@judge.com


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