Careers

We’re Always Looking for Talented and Experienced People

At Hamilton & Archer Health Services, we connect skilled healthcare professionals with meaningful, flexible career opportunities across the country. We specialize in placing Remote Stop-Loss Containment Nurses, Utilization Review Nurses, Telephonic Triage Nurses, and Healthcare Call Center Representatives—all roles designed to support the evolving needs of the healthcare industry while offering the freedom of remote or hybrid work. We also occasionally receive special project requests for unique or short-term assignments. To explore current openings and apply, please visit our official job listings on Indeed. To have your resume considered for any future positions, please fill out our application form below.

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Job Title:                         Remote Utilization Review RN
Job Type:                                    Contractor, 30-40 hrs./wk.
Hiring Company:                           Hamilton&Archer, LLC.
Number of Openings:                      1
Country and Language:                 USA / English
Schedule:                                                M-F Day Shift
Pay:                                                           $38.00 per hour

Description:

Hamilton & Archer Health Services has been retained by a national health agency to contract a Utilization Review Nurse, working Monday - Friday 9:00 AM to 5:30 PM shifts. This is an immediate hire for a 6-month contract with a potential for renewal. 

Overview

We are seeking on behalf of our client, a dedicated and skilled Utilization Review Nurse. The ideal candidate utilizes medical knowledge, established clinical guidelines, and physician support to provide medical review of care that is planned, unplanned or rendered to patients by providers and determine if care provided is medically necessary and appropriate.

Responsibilities

  • Applies medical criteria guidelines to evaluate for purposes of certification, inpatient admissions and surgical procedures, outpatient psychiatric and substance abuse treatment, selected diagnostic procedures, home health services and durable medical equipment.

  • Comprehends current accepted treatment modalities for the wide range of medical/surgical and psychiatric disorders.

  • Participates in continuing nursing and medical education classes to assist in understanding new treatment concepts and their incorporation into current practice.

  • Examines admission information for DRG pre-certification, certification of admissions and continued stay.

  • Uses the computer to document and assess clinical data necessary for utilization review.

  • Acts as liaison between various affiliate companies and Medical and Utilization Review Departments regarding medical review issues.

  • Interfaces with many levels of affiliate personnel and various departments to facilitate proper adjudication of claims.

  • Communicates with various levels of the provider system in our service area regarding utilization review issues.

  • Reviews medical information from various facilities for medical necessity.

  • Communicates with hospitals, physicians and subscribers regarding certification of hospital admissions and outpatient services.

  • Coordinates referral of cases to the Physician Reviewers; prepares cases that require review by the Physician Reviewers.

  • Prepares final letters dictated by the Physician Reviewer regarding the review of specific cases.

  • Updates the Physician Reviewers on current medical review activity changes.

  • Performs other duties and projects at the direction of Management in order to enhance the overall efficiency, effectiveness and productivity of the areas and their roles in the corporate goals.

  • Participates in medical management review process to ensure success of the QM program and to provide quality reviews and cases.

  • Maintains education profile.

  • Performs to the highest level of professionalism, customer service and quality reviews.

  • Works standard set of days and hours as agreed upon with Management.

Education and/or Experience: 

  • College degree or nursing diploma.

  • BSN or equivalent education/experience.

  • Current RN licensure in state of nursing review.

  • 3+ years clinical experience in a medical/surgical setting.

  • 1+ years clinical experience in a specialty setting.

  • 1+ years experience in a managed care setting preferred but not required.

Knowledge and skills: 

  • Knowledge of Information Technology system.

  • Able to work with minimal supervision as a member in a team environment.

  • Able to assess potential problems and formulate a solution either independently or with assistance of supervisor.

  • Strong written, verbal, and interpersonal communication skills.

  • Able to follow the Policy and Procedure guidelines for the purposes of Utilization Review, quality management, and in compliance with URAC standards.

Physical Demands: None
Work Environment: Remote