Job Details

Job Description:
We are seeking Utilization Management RNs to support a Medicare-focused population. This role will primarily handle medical-surgical reviews, with two RNs supporting inpatient concurrent reviews (members currently admitted or with emergent/urgent admissions) and one RN supporting outpatient procedural authorizations. This is a fully remote opportunity working.

Responsibilities:

• Evaluate and process prior authorization requests and referrals from contracted and non-contracted providers.

• Perform pre-service, concurrent, and post-service utilization reviews following established policies and procedures.

• Verify eligibility and benefits, and document all utilization management communications.

• Meet required production standards post-training (1.2 authorizations per hour/approximately 10 per 8-hour shift).

• Provide education regarding utilization management processes to members, caregivers, providers and administrative staff.

• Participate in utilization management auditing activities, including inter-reviewer reliability and denial file audits.

• Issue denials as appropriate (approximately 23% denial rate for inpatient and outpatient).

• Utilize systems including Aerial, MCG, Medicare LCD/NCD, Coverage Documents, QNXT, Epic EMR, Microsoft Suite and Teams.

Requirements:

• Associate degree in nursing

• Active Wisconsin RN license

• 4+ years of clinical experience as an RN

• Experience with appeals, inpatient and post-acute reviews required

• Available to work Monday–Friday, 8:00am–4:30pm CT (remote)

Pay Range:
The anticipated pay range for this position is $40–43 per hour.
We understand salary is an important factor in a job search, and we encourage you to apply even if you feel that your desired compensation may fall outside of the listed range. The final pay for this position is determined based on several factors including but not limited to, relevant experience, skills and certifications, education and training, geographic location, market conditions, and internal equity. We are committed to finding the right candidate for this role and are open to discussing how your unique qualifications align with our needs.

Benefits:

• Medical insurance

• Dental insurance

• Vision insurance

• 401(k) retirement savings plan

Contact:
Karrie Ruch
+1 (312) 884-0418
kruch@jacobsongroup.com

Refer a Colleague:
Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Equal Opportunity Employer:
The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.
If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsononline.com or +1 (800) 466-1578 to make a request.