Utilization Review Author - Weekend

Weekends: Friday, Saturday, Sunday, Monday 9am-7:30pm

R1 is a leading provider of technology-enabled revenue cycle management services which transform and solve challenges across health systems, hospitals, and physician practices. Headquartered in Chicago, R1 is publicly traded organization with employees throughout the US and international locations.

Our mission is to be the one trusted partner to manage revenue, so providers and patients can focus on what matters most. Our priority is to always do what is best for our clients, patients, and each other. With our proven and scalable operating model, we complement a healthcare organization’s infrastructure, quickly driving sustainable improvements to net patient revenue and cash flows while reducing operating costs and enhancing the patient experience.

The Utilization Review Author will be part of our Physician Advisory Team providing first level initial admission and continued stay case reviews. The Utilization Review Author will determine the appropriate cases for review, utilizing client specific guidelines. Upon identification of a case, the Utilization Review Author will ensure that appropriate orders and clinical documentation is in place prior to application of the evidence-based criteria. The successful candidate will have hospital-based Utilization Review or Case Management experience.

Responsibilities:

• Perform initial admission and continued stay reviews utilizing InterQual and MCG using evidenced-based criteria to identify and support the appropriate level of care


• Abstract data from a variety of medical records to ensure accurate clinical data


• Adhere to established quality, timeliness, and productivity outputs required in the completion of first level nursing utilization review


• Ensure effective communication internally and externally while delivering excellent customer service


• Perform other duties as assigned by departmental leadership in support of departmental and organizational strategies and goals which may include system testing, training and other opportunities that promote growth


• Complete and maintain annual compliance and annual HIPAA training
Participate in organizational educational offerings and required training as needed to support service delivery

Required Qualifications:

• Must have a current Registered Nurse license in your state of residence


• At least 2 years of recent hospital-based Utilization or Case Management Experience is preferred


• At least 3 years of clinical nursing experience (practice)


• Knowledge of current Medicare rules and regulations related to Utilization Review


• Strong analytical, organizational and time management skills


• Ability to work independently with limited supervision


• Excellent written and verbal communication skills


• Excellent clinical abstraction and attention to detail


• Experience with InterQual and/or MCG is preferred

The healthcare system is always evolving — and it’s up to us to use our shared expertise to find new solutions that can keep up. On our growing team you’ll find the opportunity to constantly learn, collaborate across groups and explore new paths for your career.

Our associates are given the chance to contribute, think boldly and create meaningful work that makes a difference in the communities we serve around the world. We go beyond expectations in everything we do. Not only does that drive customer success and improve patient care, but that same enthusiasm is applied to giving back to the community and taking care of our team — including offering a competitive benefits package.

R1 RCM Inc. (“the Company”) is dedicated to the fundamentals of equal employment opportunity. The Company’s employment practices , including those regarding recruitment, hiring, assignment, promotion, compensation, benefits, training, discipline, and termination shall not be based on any person’s age, color, national origin, citizenship status, physical or mental disability, medical condition, race, religion, creed, gender, sex, sexual orientation, gender identity and/or expression, genetic information, marital status, status with regard to public assistance, veteran status or any other characteristic protected by federal, state or local law. Furthermore, the Company is dedicated to providing a workplace free from harassment based on any of the foregoing protected categories.

If you have a disability and require a reasonable accommodation to complete any part of the job application process, please contact us at 312-496-7709 for assistance.

CA PRIVACY NOTICE: California resident job applicants can learn more about their privacy rights California Consent