UM/Chart Reviewer RN (Remote) - 242149

Utilization Management (UM)/Chart Reviewer RN, IP & Concurrent - REMOTE Pay Rate: $40.00-$42.00 per hour Location: Remote, equipment provided Start Date: 05-26-2025 Hours: M-F, can start as early as 6am EST. ~30 hours per week, no more than 40 Employment Type: Temporary contract, expected to last throughout the summer (~Aug/Sept). This could be extended but will not turn into an opportunity to convert FTE with the company. Our organization is the largest External Quality Review Organization (EQRO) in the nation and provides quality review services for states that operate Medicaid managed care programs and fee-for-service programs. As an EQRO, we evaluate managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), and primary care case management (PCCM) programs. Our quality review services affect more than 44 million Medicaid recipients, or approximately 49 percent of the nation's Medicaid population.

This project will be supporting one of our clients who is requiring IP/Concurrent chart reviews. Training will be provided, however it is important that candidates come with prior review and clinical experience so they can grasp the knowledge quickly. Evaluate and process prior authorization requests for medical procedures and medications. Collaborate with healthcare providers to gather necessary documentation. Conduct clinical assessments based on established guidelines.