About the role
Dane Street, a workers' compensation and group health review company, is hiring PRN utilization review nurse reviewers who hold an active, unrestricted LPN/LVN or RN license. You will assess medical necessity against CMS, MCG, InterQual or health plan criteria from home, working as-needed shifts including at least one weekend a month.
Responsibilities
- Assess medical services for appropriateness using CMS, Milliman Care Guidelines, InterQual or plan-specific criteria
- Review patient records to verify quality of care and medical necessity
- Serve as a clinical reference for non-clinical staff
- Enter clinical details in medical management platforms
- Keep current on URAC and state utilization review standards
- Communicate with management, physicians and the Medical Director to support high-quality decisions
Requirements
- Active, unrestricted LPN/LVN or RN license
- At least 2 years of clinical nursing experience
- At least 1 year of utilization management experience
- Skilled with Word, Excel, PowerPoint and Outlook
- Strong written and spoken communication
- Own reliable internet service for work from home
- PRN commitment: at least one weekend per month, one major and one minor holiday per year, and a minimum number of monthly shifts
What we offer
- Medical, dental and vision coverage
- Voluntary life and other voluntary benefits
- Basic life, short- and long-term disability at no cost
- Paid time off
- 401(k) with company match
- Apple equipment and media stipend for remote workspace