Utilization Review RN - Intensive Case Management, Medicare Advantage (hybrid-remote)

Minimum of 2 years’ experience in utilization management, Inpatient CM or clinical Experience.

• Strong knowledge of CMS guidelines, home health coverage criteria, and DME regulations.
• Proficient in clinical documentation review, critical thinking and evidence-based decision making.
• Familiarity with utilization platforms and electronic health records.
• Must have strong problem-solving skills. Ability to analyze problems and formulate plans, solutions and a course of action given changing circumstances.
• Excellent organizational and time management skills, including the ability to handle multiple conflicting priorities simultaneously. Strong ability to prioritize.
• Demonstrate proficiency in computer skills such as Windows computer function, computer navigation, and ability to use computerized patient care systems.
• Competence in navigating the internet/intranet and use of browser software such as Microsoft Explorer and applications such as Excel, Word, and PowerPoint
• Excellent interpersonal, verbal and written communication skills. Ability to articulate clinical and non-clinical information to individuals of all levels of understanding.
• Ability to be flexible and work according to availability of office personnel, patient and resources required to coordinate care of patient.