Review patient medical records to determine the medical necessity and appropriateness of admissions, continued stays, and services.
Perform concurrent and retrospective utilization reviews in accordance with established clinical guidelines.
Collaborate with physicians, case managers, and interdisciplinary teams to optimize patient outcomes and ensure efficient resource utilization.
Document review findings accurately using Epic and Dragonfly utilization management software.
Ensure compliance with payer requirements, regulatory standards, and organizational policies.
Identify potential barriers to discharge and communicate recommendations to the care team.
Maintain accurate documentation and participate in quality improvement initiatives.
Active Registered Nurse (RN) license.
Minimum 2 years of Utilization Management/Utilization Review experience required.
BLS Certification required.
CCM (Certified Case Manager) or CMCN (Certified Managed Care Nurse) certification required.
Experience with Epic EMR and Dragonfly utilization management tool preferred.
Prior travel nursing experience highly preferred.
Comfortable working independently in a remote environment and proficient with computer systems.
Candidate must provide their own computer/workstation (equipment is not supplied).
Degree accreditation verification required, or 5 years of relevant experience in lieu of degree verification.
Must successfully complete the HWL prescreen interview followed by the facility manager interview.
100% Remote opportunity-work from the comfort of your home.
Consistent Monday-Friday day shift schedule with excellent work-life balance.
Join a collaborative team using industry-leading technology like Epic and Dragonfly.
Gain valuable experience in Utilization Management with a respected healthcare organization.
Streamlined hiring process with prescreening, manager interview, and quick offers for qualified candidates.
Excellent opportunity for experienced UR/Case Management nurses seeking long-term remote career growth.
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