Registered Nurse – Utilization Review

This is a fully remote position, open to applicants in Wisconsin.

📋 Description

• Evaluates admissions and service requests for potential, ongoing, and retrospective medical necessity and/or adherence to reimbursement policy criteria.

• Offers case management and/or consultation for intricate cases.

• Supports departmental personnel with coding, medical records/documentation, precertification, reimbursement, and managing claim denials/appeals.

• Evaluates and coordinates discharge planning requirements with healthcare team members.

• May generate statistical analyses and utilization review reports.

• Supervises and ensures compliance with federally mandated and third-party payer utilization management regulations and standards.

⛳️ Requirements

• Registered Nurse credential from the Wisconsin Board of Nursing obtained before the hire date or job transfer date.

• Licensure from the Wisconsin Board of Nursing OR a current home state license if classified as multi-state/Compact State.

• Diploma from an accredited nursing school/college is required OR the necessary professional licensure at the time of hire.

🏝️ Benefits

• 403(b) plan.

• Employee Assistance Program.

• Counseling and peer support.

• Spiritual care and stress management resources.