Utilization Review Author

Location: Remote, US

Shift: Flexed Weekday Evening schedule 3-11 PM EST with some weekend requirement

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.

Here’s what you will experience working as a Utilization Review Author:

• 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.

Required Skills:

• Active Registered Nurse (RN) license in your state of residence, with eligibility to obtain a California RN license

For this US-based position, the base pay range is $18.69 - $39.35 per hour . Individual pay is determined by role, level, location, job-related skills, experience, and relevant education or training.

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent

To learn more, visit: R1RCM.com

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