Utilization Review Author

Location: Remote, US Shift: Flexed weekday daytime schedule with some weekend and evening requirements throughout the month. R1 is the leading provider of technology-driven solutions that transform the patient experience and financial performance of hospitals, health systems, and medical groups. We are the one company that combines the deep expertise of a global workforce of revenue cycle professionals with the industry’s most advanced technology platform, encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our Utilization Review Author, you will help our hospital clients by working alongside our Physician Advisory team to provide first-level initial admission and continued stay case reviews. Every day you will, determine the appropriate cases for review, utilizing client-specific guidelines. Upon identification of a case, you will ensure that appropriate orders and clinical documentation are in place prior to the application of the evidence-based criteria. To thrive in this role, you must have experience in a clinical inpatient environment and hospital-based utilization or case management experience. Proficiency in basic computer skills is essential for excelling in this remote position.

Perform initial admission and continued stay reviews utilizing InterQual or Milliman to identify and support the appropriate level of care. Abstract data from a variety of medical records to ensure accurate clinical data. Adhere to established quality, timeliness, and productivity outputs required in the completion of first-level nursing utilization review. Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training, and other opportunities that promote growth.