Utilization Review Nurse

VillageCare is a pioneering and innovative continuing care organization that provides managed care and community care options. We strive to understand the current state of need of those we serve and pursue appropriate responses. VillageCare recognizes and supports self-directed, interactive care. This enables being served to control aspects of their own care and helps them maintain their independence. VillageCare delivers care and services for more than 35,000 unique individuals annually through its health plan and community programs. Guided by the people we serve, we provide leadership to improve the health and quality of life of the diverse communities we serve and the quality of care and well-being of the people we serve.

RN- Utilization Review Nurse Inpatient *Full Time - 100% Remote Opportunity* COME WORK FOR THE LEADING, LOCAL MANAGED CARE COMPANY - VILLAGE CARE! VillageCare is looking for a self-motivated and passionate RN as Utilization Review Nurse for a Full-Time position. This is an exciting and dynamic position from the comfort of your own home as you will be responsible for the assessment of member needs and identification of solutions that promote high quality and cost effective health care services.

Reviews planned, in process, or completed health care services to ensure medical necessity and effectiveness according to evidence-based criteria - prospective, concurrent and retrospective review. Frequently collaborates and communicates with physician peer reviewers and medical directors in determining coverage of requested services. Provide intervention and coordination to decrease delays and denials. Maintains timely, complete and accurate documentation in compliance with VCMAX policies and procedures. Support Quality and Performance Improvement Initiatives. Timely follow-up on results of denial and internal appeal reviews.