ID: 63390968 Shift: Day 5x8-Hour (08:00 - 16:30) Description: Remote UR RN Modified 12:00:00 AM Account Manager: Jordan Hinojos Account Manager Email: COVID-19 Vaccine: Not Required Flu Vaccine: Unknown Job Requirements & Qualifications Previous Charge Experience : - Years of Experience : 3 Patient Ratio Experience : Charting System Experience : Required Charting System Name : Epic Community Hospital Experience : - LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : Yes Certifications : Skills : Acute Hospital, Admission Criteria*, Admission Criteria*, Appeals and Denials*, Appeals and Denials*, Audits*, Audits*, Benefits Eligibility*, Care coordination*, CMS: Centers for Medicare and Medicaid Services*, Concurrent Review*, Concurrent Review*, Continued Stay Reviews*, Continued Stay Reviews*, CPT (Current Procedural Terminology) coding and billing*, CPT (Current Procedural Terminology) coding and billing*, Data Abstraction*, Data Abstraction*, Department of Health*, Determine Medical Necessity per Evidence-Based Guidelines*, Disability case management*, Discharge Planning*, Disease management*, DRG (Diagnosis Related Groups)*, HEDIS (The Healthcare Effectiveness Data and Information Set) Measures*, HIPAA guidelines (Health Insurance Portability and Accountability Act)*, ICD 10 Coding*, Insurance Company*, Long Term Acute Care/Rehab/Skilled Nursing*, Medical Necessity*, NCQA (National Committee for Quality Assurance)*, Needs Assessment/ Order DME*, OSHA*, Plan of Care*, Pre-Cert Review*, Pre-Cert Review*, Prior Authorization*, Prior Authorizations*, Quality Improvement*, Retrospective Review*, Retrospective Review*, Telephonic*, The Joint Commission/ Core Measure/National Safety Goals*, Utilize InterQual Criteria, Utilize InterQual Criteria, Utilize Milliman Guidelines*, Worker s comp case management*, Workers Compensation*, CA and Medi-Cal experience/knowledge * Unit Details Staffing & Scheduling Scheduling Type : Other Patient Ratios Days : 40 Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : True Number of Weekend Shifts Per Contract : meet dept needs Pre-Approved Time Off : one Orientation Hours : 40 Facility & Patient Care Details Patient Age Groups : Neonates, Adolescents, Infants, Adults, Pediatrics, Geriatrics Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : Interqual is a Hardstopacute care hospital experience is a requirement and a hardstop Special Procedures/Unit Details : 3-year acute medical Care Manager/UM experience performing utilization review in a hospital setting (not health plan/medical group) InterQual required, this is a Hardstop Experience with HMOs, IPAs, etc. Over 20 hours requires PM approval Modules are completed pre-start, and annually Time spent on modules is self-reported, completion is recorded in Workramp transcripts Submittal Details: #Tier3 Travel ComplianceWe must have these three things before your traveler can be reviewed by our clinical team so please submit with this information is their upcoming interview availability?.Please confirm the DOB and full SSN is correct in Connect.