Registered Nurse (RN), Home Health Utilization Management

Responsibilities: Review Home Health prior authorization requests for medical necessity based on CMS regulations and clinical guidelines. Collaborate with providers and internal teams to ensure smooth care transitions and appropriate utilization of services.

Requirements: Requires a valid Compact RN license and at least 3 years of clinical nursing experience in Home Health, Case Management, or Utilization Management. Must have at least 1 year of experience performing medical necessity reviews using CMS criteria.

Key skills: Utilization Management, Medical Necessity Review, CMS Regulations, Clinical Nursing, Case Management, Medicare Advantage, Clinical Judgment, Critical Thinking, Electronic Medical Records, Interdisciplinary Collaboration, Documentation, Prior Authorization

Keywords: Registered Nurse, Home Health, Utilization Management, CMS, Medicare Benefit Policy Manual, NCD, LCD, Medical Necessity, Medicare Advantage, Prior Authorization, Clinical Review, Remote Work, Healthcare, Case Management, Electronic Medical Records