Utilization Review Nurse RN- Remote PST hours ID-7304

March 6, 2025

About Lucent Health

Lucent Health combines top-tier claims management with a compassionate, human-focused, data-driven care management solution. This approach helps self-insured employers provide care management that enables health plan participants to make smarter, cost-saving healthcare decisions. Continuous data analytics offer ongoing insights, ensuring participants receive the right care, at the right cost, at the right time. Join us as we build a company that aims to be a better health benefits partner for self-insured employers.

Other Jobs You May Be Interested In

Transparent Communication: be open and clear in all interactions without withholding crucial information
Integrity: ensure accuracy in reporting, work outputs and any tasks assigned
Truthfulness: provide honest feedback and report any issues or challenges as they arise
Trustworthiness: build and maintain trust by consistently demonstrating reliable behavior

Ethical

Fair Decision Making: ensure all actions and decisions respect company policies and values
Accountability: own up to mistakes and take responsibility for rectifying them
Respect: treat colleagues, clients and partners with fairness and dignity
Confidentiality: safeguard sensitive information and avoid conflicts of interest

Hardworking

Consistency: meet or exceed deadlines, maintaining high productivity levels
Proactiveness: take initiative to tackle challenges without waiting to be asked
Willingness: voluntarily offer to assist in additional projects or tasks when needed
Adaptability: work efficiently under pressure or in changing environments

Summary:

The Utilization Review RN shall work in a collaborative fashion to promote the provision of quality care and cost-effective outcomes that will enhance the physical, psychosocial, and vocational health of the plan participants in accordance with the policies and procedures of Lucent Health Care Management, LLC, URAC UM Standards, and the laws and established practices associated with medical management.

Responsibilities:

The Utilization Review RN shall be responsible for all aspects of the utilization review process as directed by the Supervisor of Utilization Review.

Activities shall include, but not be limited to, inpatient and outpatient review, admission review, discharge planning, retrospective review, readmission review, large case management screening/identification, identification and communication of large claim potential, development, review, revision, and implementation of quality improvement programs and protocols (as directed by the Supervisor of Utilization Review), excellent coordination and communication of medical information with large case and disease management and payers (as appropriate), appropriate usage of physician advisors, adherence to URAC requirements and LHCM. documentation, quality, and productivity standards, completion of requests for attending physician statements, and customer service support.
The Utilization Review RN is responsible, on a daily basis, for completing the "tickler", returning telephone and voice mail messages within established timeframes, accurately and adequately documenting all interactions, checking and responding to e-mail, faxes, and regular mail, interacting with all internal and external customers in a positive, proactive, and helpful manner, and providing any and all necessary support to the Supervisor of Utilization Review and the entire LHCM team.
They shall complete the LHCM Orientation and Training Course that includes policies and procedures and URAC UM Standards, be familiar and supervise the activities of the non-clinical administrative staff relative to the UR function, utilize telephones, access the server, or other software that may be provided by LHCM to perform daily duties, and be familiar with the Clinical Review Guidelines.
They shall be responsible for providing all aspects of excellent customer service and development, maintaining confidentiality, completing an orientation and participating in an ongoing training program which includes policies and procedures, URAC UM Standards, and clinical review guidelines.
They only certifies care or services. If the care or service requested is not meeting initial clinical review criteria, then the case is referred to a peer clinical reviewer.

Qualifications:

Registered Nurse with a minimum of 5 years of recent clinical nursing experience
Bachelor's Degree and/or Certification in UR, Case Management, or a related field-preferred
Excellent Written and Oral Communication
Positive, proactive team-oriented approach/attitude
Excellent Computer skills
Holds an active, unrestricted RN license that allows him/her to practice in a state or territory of the United States.

Equal Employment Opportunity Policy Statement

Lucent Health is an Equal Opportunity Employer that does not discriminate based on actual or perceived race, color, creed, religion, alienage or national origin, ancestry, citizenship status, age, sex or gender (including pregnancy, childbirth and related medical conditions), gender identity, gender expression, transgender status, sexual orientation, marital status, military service and veteran status.

Back to blog

Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...