Job Description

Acara Solutions is seeking a REMOTE Utilization Review Nurse to join our client in Williamsville, NY! 

*Must be NYS Licensed*

100% Remote
Duration: 6-Month Contract (Potential Extension)
Pay: $36-$38/HR
Schedule:  Mon-Fri | 8 AM-4:30 PM or 9 AM-5:30 PM

Key Responsibilities:
✔️ Conduct medical necessity reviews (prior auth, pre-cert, concurrent, retrospective)
✔️ Ensure accurate, timely documentation & case management follow-ups
✔️ Maintain compliance with policies, regulations & turnaround times
✔️ Deliver professional, efficient utilization management services

Job Requirements

Required Skills / Qualifications:

• Associates Degree in Nursing required; Bachelor's degree preferred. Current, active, unrestricted, and licensed registered nurse (RN) required. 
• Two (2) years of clinical experience as an RN in a varied clinical setting required. 
• Previous utilization review or utilization management experience required. 
• Previous appeal experience in a managed care organization / familiarity with Medicare (CMS) member appeals beneficial. 
• Experience following established medical guidelines required. 
• Clinical knowledge of the health or social work needs for the population served. 
• Demonstrated ability to identify barriers to a successful care management path. 
• Ability to interact effectively and professionally with internal and external customers 
• Proficient PC Navigational skills required; solid data entry and MS Office skills required. 

Aleron companies (Acara Solutions, Aleron Shared Resources, Broadleaf Results, Lume Strategies, TalentRise, Viaduct) are Equal Employment Opportunity and Affirmative Action Employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender identity, sexual orientation, national origin, genetic information, sex, age, disability, veteran status, or any other legally protected basis. The Aleron companies welcome and encourage applications from diverse candidates, including people with disabilities. Accommodations are available upon request for applicants taking part in all aspects of the selection process.

Applicants for this position must be legally authorized to work in the United States. This position does not meet the employment requirements for individuals with F-1 OPT STEM work authorization status.

Job Tags

Similar Jobs