Utilization Mgmt Nurse RN

Location: Pearland, TX
Salary: $38.00 USD Hourly - $39.00 USD Hourly
Description:

Job Title: Acute / Post-Acute Utilization Management (UM) Nurse (RN)
Location: Remote (Telecommute)
Duration: 03 Months Contract extensions
Shift: 8:00 AM – 5:00 PM CST

Hours: 40 hours per week

Position Overview:

The Acute / Post-Acute UM Nurse plays a crucial role in supporting inpatient utilization management processes. This position ensures timely and accurate inpatient authorization reviews and determinations, directly contributing to meeting business goals, regulatory requirements, and turnaround time standards.

Key Responsibilities:

• Conduct a minimum of 9 inpatient authorization reviews/determinations per day
• Perform acute and post-acute utilization reviews in accordance with established clinical guidelines and policies
• Evaluate medical necessity and appropriateness of inpatient services
• Ensure timely completion of authorization decisions to meet turnaround time (TAT) requirements
• Document all findings, decisions, and supporting clinical rationale accurately and thoroughly
• Collaborate with internal teams, providers, and stakeholders to gather necessary clinical information
• Maintain compliance with regulatory standards, payer policies, and organizational protocols
• Identify and escalate cases as needed based on clinical complexity or policy guidelines
• Manage workload independently while maintaining productivity and quality standards

Team Environment:

• Team of 10 Registered Nurses (RNs) specializing in inpatient acute UM reviews
• Collaborative yet highly independent work culture
• Focus on accountability, efficiency, and quality outcomes

Required Qualifications:

• Active RN (Registered Nurse) License
• Minimum 2+ years of Acute Utilization Management (UM) experience
• Strong understanding of inpatient authorization processes and medical necessity criteria
• Excellent analytical, clinical judgment, and decision-making skills
• Ability to manage multiple cases efficiently in a fast-paced environment
• Strong documentation and communication skills

Preferred Qualifications:

• Proven ability to work independently and stay on task in a remote environment
• Experience handling high-volume review workloads
• Strong time management and organizational skills

Interview Process:

• Video/Phone Interview
• Typically, 1 round

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