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All Care To You
Um Outpatient Review Nurse
Remote · United States · Full time · Mid level
$70k–$120k / year
About the role
Responsible for clinical, quality, and patient outcomes in Utilization Review. Provides high quality medical review applying guidelines to determine medical necessity.
What you’ll do
• Review authorization requests for medical necessity. • Process requests within established time frames. • Document all steps in authorization system. • Refer cases to Medical Director as needed. • Write denial letters meeting CMS and Health Plan requirements.
What you’ll bring
• Valid CA and Texas/Multi State RN or LVN license. • Five years+ clinical experience. • CM and/or UM training or certification preferred. • Ability to work weekends and holidays. • Proficiency with Microsoft Office and communication tools.
Life at All Care To You
Fully remote with flexible schedules. Offers 100% employer paid medical, vision, dental, life coverage, paid holidays, birthday off, unlimited PTO, and 401k plan.
About All Care To You
All Care To You is a Management Service Organization providing healthcare administrative support to Independent Physician Associations, TPAs, and Fiscal Intermediary clients.