UR Case Manager I - RN
$63,739–$95,264 year
Remote · Syracuse, New York, United States
Job Summary
Remote Utilization Review Case Manager I (RN) gathers demographic and clinical information on prospective, concurrent, and retrospective in-patient admissions and outpatient treatment, certifies medical necessity, and assigns appropriate length of stay while supporting the Case Management department goals. Identifies necessity of the review, collects data, analyzes information to decide on certification or denial of treatment, documents work properly, and promotes utilization review services with stakeholders. Requires current RN licensure and nursing degree (associate’s or BSN); CPT and ICD coding knowledge; ability to interface with claims staff, attorneys, physicians, and clients; strong organization, time management, and communication skills; proficient in Microsoft Office (Excel); 4+ years of clinical experience; utilization review experience preferred; knowledge of workers’ compensation and outpatient utilization review preferred. This is a remote role with location listed as Syracuse, NY.
Required Qualifications
- RN licensure current in operating state
- Nursing degree (associate’s or BSN) from an accredited program
- Graduate of accredited school of nursing with associate’s degree or BSN
- CPT and ICD coding knowledge
- 4+ years of recent clinical experience
- Utilization review experience preferred
- Ability to interface with claims staff, attorneys, physicians, advisors/clients
- Proficiency with Microsoft Office including Excel
- Strong written and verbal communication skills
- Ability to work independently and in a team
- Knowledge of workers’ compensation claims process preferred
- Knowledge of outpatient utilization review preferred
Apply with one swipe on Sorce. We auto-fill applications and apply on your behalf — no cover letters, no 40-minute forms.
Hiring someone like this?
Get your role in front of qualified candidates on Sorce.