OPEN
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
Current Openings
CLOSED
Job Title: Remote Utilization Review RN
Job Type: Full Time
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 recruit for full time Utilization Review Nurse, working Monday - Friday 9:00 AM to 5:30 PM shifts. This is an immediate hire.
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
CLOSED
Job Title: Remote Telephonic Triage Nurse (RN)
Job Type: Full Time
Hiring Company: Hamilton&Archer, LLC.
Number of Openings: 1
Country and Language: USA / English
Schedule: All Shifts
Pay: $34.00-$36.00 per hour
Description:
Hamilton & Archer Health Services has been retained by a national telephonic triage health agency to recruit for full and part-time openings, all shifts and hours. This will include working every other weekend.
Overview
We are seeking, on behalf of our client, a dedicated and skilled Triage Registered Nurse. The ideal candidate will play a crucial role in assessing patient needs, using nationally recognized telephonic triage guidelines, prioritizing care based on urgency, and ensuring that patients receive the appropriate level of medical attention. This position requires strong clinical judgment, excellent communication skills, and the ability to work effectively in a fast-paced environment with multiple electronic medical record (EMR) systems.
Responsibilities
Conduct initial assessments of patients to determine the severity of their conditions over the phone.
Utilize nationally recognized triage protocols to prioritize patient care effectively.
Provide guidance and education to patients regarding their health concerns and treatment options.
Collaborate with physicians and other healthcare professionals.
Document patient interactions accurately in EMR systems.
Assess patients across the lifespan, infants to geriatrics, ensuring appropriate guidelines are applied.
Respond promptly to emergency calls, including medical and behavioral health, when necessary.
Requirements
Active nursing license in Compact State.
Proven experience in triage nursing or a related field.
Familiarity with electronic EMRs, including proficiency typing, multitasking and talking/typing simultaneously.
Strong communication skills with the ability to work collaboratively within a team environment.
Ability to remain calm under pressure and make quick decisions based on clinical assessments.
Physical Demands: None
Work Environment: Remote
CLOSED
Job Title: Remote Telephonic Triage Nurse (RN)
Job Type: Full Time
Hiring Company: Hamilton&Archer, LLC.
Number of Openings: 1
Country and Language: USA / English
Schedule: All Shifts
Pay: $34.00-$36.00 per hour
Description:
Our client is a national healthcare call center located in Salem, NH. This position will work 4 days in the office and 1 day remote. We are seeking a dedicated and enthusiastic Call Center Representative to join our client's team. In this role, you will be the first point of contact for providers, patients and clients, providing exceptional service and support. You will conduct health insurance precertification, answer calls for the nurse helpline and provide customer service. The ideal candidate will possess strong communication skills, a keen ability to analyze information, and a commitment to delivering high-quality service.
Responsibilities
Answer incoming calls promptly and professionally, providing precertification, build nurse helpline record, provide customer service and address customer questions.
Utilize medical terminology to assist providers and patients in understanding their needs effectively.
Perform data entry tasks accurately while maintaining confidentiality of sensitive information.
Analyze customer requests and provide appropriate solutions or escalate issues as necessary.
Demonstrate excellent phone etiquette while communicating with customers.
Document interactions in the computerized system to ensure accurate record-keeping.
Collaborate with team members to improve processes and enhance customer experience.
Experience
Must Haves:
Proficiency in English is required; bilingual or multilingual candidates are highly desirable, especially those fluent in Spanish.
Experience working in a medical setting such as a clinic, doctor's office or hospital
Familiarity with common medical terminology
Strong data entry and typing skills with attention to detail
Ability to analyze information quickly and provide effective solutions.
Excellent verbal communication skills with a focus on phone etiquette.
Good to Have:
Previous experience in a call center or customer service role is preferred.
Familiarity with medical office procedures and terminology is an asset.
Full-time position.