Utilization Management Registered Nurse

Location: Work at Home - Alabama, United States. Remote work is required; occasional travel to hirify.global offices for training or meetings may be required.

Salary: $71,100–$97,800 per year, plus eligibility for a performance-based bonus incentive plan.

Company

hirify.global is a U.S. healthcare and insurance company providing insurance and healthcare services for people with Medicare and Medicaid, families, individuals, military personnel, and communities.

What you will do

• Interpret clinical information and support the coordination, documentation, and communication of medical service and benefit administration determinations.
• Review information from attending physicians and other care providers using established medical criteria.
• Make determinations for post-acute care services, including Skilled Nursing Facility, Home Health, and Durable Medical Equipment.
• Complete request determinations within established processing time frames.
• Communicate with providers, members, and other parties to facilitate care and treatment.
• Contribute to coordinated care and support department and organizational operating goals.

Requirements

• Active Compact Registered Nurse license in the state of residence.
• More than one year of clinical RN experience in a hospital, Skilled Nursing Facility, Home Health, or acute care setting.
• Ability to work from a dedicated, interruption-free space to protect member PHI and HIPAA information.
• Home internet service with at least 25 Mbps download and 10 Mbps upload speed.
• Commitment to improving consumer experiences.

Nice to have

• Utilization management or utilization review experience in a health plan or acute care setting.
• Knowledge of medical necessity criteria such as Milliman Care Guidelines or InterQual.
• Experience in fully remote, metrics-focused work, MDS coordination, discharge planning, Medicare-certified Home Health, health plans, Medicare, Medicaid, call centers, or triage.
• BSN or a bachelor's degree in a related field.

Culture & Benefits

• Full-time schedule of 40 hours per week.
• Medical, dental, and vision benefits.
• 401(k) retirement savings plan.
• Paid time off, company and personal holidays, and paid parental and caregiver leave.
• Short-term and long-term disability coverage, life insurance, and other wellness benefits.
• hirify.global provides appropriate telephone equipment for home-based work; approved employees in California, Illinois, Montana, or South Dakota receive a bi-weekly internet expense payment.