We are excited to welcome a Full-Time Utilization Review Nurse (RN) position to our growing team! AHDI is the American Health Data Institute, part of the Key Family of Companies. Our organization is consistently named a Top Workplace by our employees year after year, and we are excited to speak to qualified candidates about this new work from home opportunity!

We believe in delivering a Wow level of service to our valued clients and living up to our mission of improving people's health through high quality, cost-effective care. Strong core values, supportive work relationships, high quality training and personal development are part of our DNA and we are looking for the right individual to join us!

If you are passionate about delivering high-quality service and would like to be part of our supportive family culture - we want to hear from you. The Full-Time Utilization Review Nurse position includes a comprehensive benefit package, full training program and competitive salary!

Full-Time Utilization Review Nurse Overview: The Utilization Review Nurse provides excellence in Utilization Management for AHDI and Key Family clients, to ensure patients are receiving the highest quality care at the most appropriate level of care.

Essential Duties and Responsibilities of the Full-Time Utilization Review Nurse:

• Performs telephonic and record reviews to assess the medical necessity of elective and emergent admissions and continued stays, based on severity of illness and intensity of service, criteria. Enters that data in the computer in an accurate and timely manner.
• Ensures that the quality of care delivered meets professionally recognized standards of health care.
• Ensures that the services performed are reasonable, medically necessary and delivered in the appropriate setting.
• Implements the HCM physician review process, referring cases not meeting admission, continued stay or pre-determination criteria to the medical director.
• Interacts with hospital UR/CM, providers, physician's offices, families and members, to facilitate the precertification process.
• Communicates with the AHDI/HCM Case Managers regarding patients with potential Case Management needs.
• Runs and/or reviews reports for accuracy on a daily and/or monthly basis as needed.
• Perform other work-related duties as assigned.

Competencies, Knowledge, Skills and Abilities

• Registered Nurse, with a current, unrestricted license
• Strong clinical background - preferably 3-5 years of experience in acute care or skilled or rehabilitative clinical settings.
• Polished communication skills both oral & written. Speaks clearly and persuasively in positive or negative situations. Writes clearly and informatively.
• Good data entry and basic computer skills, proficient in Microsoft Word, Excel & Outlook, with the ability to quickly learn new applications.
• Able to work independently and as a part of a team.
• Ability to work in a proficient and timely manner in to meet service expectations.
• Professional business demeanor.
• Strong work ethic
• Ability to maintain confidentiality

A background in Precertification and/or Case Management is required.

More about AHDI and the Key Family:

Founded in 1979 as a full-service group benefits administration firm specializing in self-funded medical plans, the Key Family has grown to become one of the country's largest independently owned third party administrators, supporting a wide variety of group benefit plans.

Learn more about the Key Family and AHDI here: https://ahdi.com/

If you are unable to complete an application for the Full-Time Utilization Review Nurse position due to a disability, contact Human Resources by calling 800-560-3539 to ask for an accommodation or an alternative application process.

All qualified applicants for the Full-Time Utilization Review Nurse position will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.

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