Utilization Review Nurse

Rising Medical Solutions has an opening for a Utilization Review Nurse, and we want to hear from you! We're a bill review and cost containment company - so what does that mean? Basically we are trying to fix a very broken healthcare system by reducing the cost of healthcare claims through bill review, case management, and utilization review. Our mission is "To make lives better" and everyone here at Rising works hard to achieve this goal. So take a look at the job, let us know what you think, and let's start working towards a better future!

**This is a full-time position - 40 hours per week (Must work M-F each day).

Responsibilities

Perform all aspects of the Utilization Review Process
Review records and requests for UR, which may arrive via mail, e-mail, fax, or phone
Utilize evidence-based guidelines to determine if authorization can be given versus having to send the file or for Peer or Physician Review
Write nurse summaries on all UR files
Document properly in Rising's database (and client data bases when appropriate), and send determination letters on each completed UR
Establish collaborative relationships with clients, patients, employers, providers and attorneys
Track ongoing status of all UR activity so that appropriate turn-around times are met
Maintain organized files containing clinical documentation of interactions with all parties of every claim
Utilize good clinical judgment, careful listening, and critical thinking and assessment skills
Respond to various written and telephonic inquiries regarding status of case
Must be proficient in the use of a computer, including the use of various software programs simultaneously

Requirements

An Associate's or Bachelor's degree in Nursing
Hold an active and unencumbered RN license in one or more states
3 to 5 years of clinical practice experience or 2 years of case management and/or UR experience
More than one state license (a plus)
Experience with Workers' Compensation, short-term or long-term disability, or liability claims
The ability to set priorities and work both autonomously and as a team member
Well-developed time-management, organization, and prioritization skills
Excellent analytical skills
Superb oral and written communication
The ability to gather data, compile information, and prepare summary reports
Strong interpersonal and conflict resolution skills
Experience in a fast-paced, multi-faceted environment
Demonstrated persistence and attention to detail
General understanding of CPT and ICD-9/ICD-10 codes and Medicare guidelines
Working knowledge of: Microsoft Word, Excel, and Outlook
Ability to remain calm during stressful situations
A customer-service mindset

Benefits

• Generous Flexible Time Off (take it when you need it!)
• Comprehensive benefit package including health/dental/vision insurance, profit sharing, and 401k matching
• Career Growth Opportunities - We often promote from within

Professional Development Reimbursement Program (PDRP)

You will be part of our new Elevate program designed to recognize and reward employees for their hard work
Rising was named a Top Workplace in the healthcare industry for 2023! Check out our profile here: Working at Rising Medical Solutions | Top Workplaces
We're on YouTube! Check out our culture at: http://www.youtube.com/user/RisingMedical

Want to see more? Check out our

Facebook: https://www.facebook.com/RisingMedicalSolutions

LinkedIn: http://www.linkedin.com/company/rising-medical-sol..

If you are ready to join a team of professionals dedicated to making a difference and making lives better, please apply today!

Visit the company's website for more information

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