Utilization Management Nurse (RN)
Virtual Vocations · Centralia, WA
Job description
To support the Utilization Management team, the full-time Utilization Management Nurse (RN) will conduct inpatient, behavioral health, and post-acute authorization reviews, ensuring compliance with CMS and Medicare Advantage regulations while working remotely.Key responsibilitiesReview medical records to evaluate medical necessity and appropriateness of requested services through prospective, concurrent, and retrospective utilization reviewsAssess treatment plans for alignment with medical necessity criteria and recommend alternative levels of care when appropriateCollaborate with the Medical Director on cases that do not meet criteria and maintain accurate documentation of all determinationsRequired qualificationsUnrestricted RN license with a minimum of 4 years of clinical experienceAt least 3 years of Utilization Management or Inpatient UR experience within a health plan or hospital settingStrong knowledge of CMS regulations and Medicare Advantage requirementsExperience preparing cases for Medical Director reviewAble to work in a fast-paced, evolving environment
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" Licensed Psychiatric Nurse Practitioner Wage: Up to $206.36/hour Did you know that you can build a flexible private practice on your terms as a psychiatric nurse practitioner? Whether you want to see patients alongside a full-time job or grow a full-time practice, Headway makes it easy to accept insurance, boost your earnings, and focus on care - without the administrative burden. It's all on one free-to-use platform, no commitment required. About the role This position is for licensed psychiatric nurse practitioners looking to start or grow their private practice. Headway provides the tools, resources, and support to help you navigate insurance, streamline operations, and let you focus on what matters most - your patients. About you • You're a fully licensed psychiatric nurse practitioner with your DEA or CDS number, ANCC or AANP board certification, a valid NPI number and malpractice insurance. • You're looking to start or expand your private practice while maintaining control over your schedule, client load, and work environment. Why partner with Headway? As an independent provider with Headway, you'll gain access to: • Hassle-free insurance credentialing: Get credentialed for free in multiple states within as little as 30 days. • Increased earnings: Secure competitive rates with top insurance plans through our nationwide network. • Predictable bi-weekly payments: Receive reliable payouts directly from Headway. • Built-in EHR tools: Access real-time scheduling, secure client messaging, documentation templates, assessments, and more. • Compliance & audit support: Stay up-to-date with insurance requirements and industry regulations. • Free continuing education: Earn CEUs and expand your expertise through Headway Academy. How Headway supports your patients • Increased access: Headway makes it easier for your clients to get the care they need at a price they can afford through insurance. • Instant verification: Clients can easily check their insurance status and get the care they need without disruption. Important Notes • This is a 1099 independent contractor role. You'll have full autonomy over your practice, including setting your hours and managing your caseload. • At this time, Headway can't support mental health professionals that aren't fully licensed. If your application was rejected for incomplete licensure, you're welcome to reapply once you have a valid license. About Headway We make it easy for mental health providers to take insurance by credentialing you with the nation's largest networks, handling billing and admin paperwork, and helping you earn more stable income with higher rates. With Headway, you can finally focus on what matters most: providing life-changing care. We'll take care of the rest.
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