At Limitlessli, we specialize in recruiting, hiring, and managing high-caliber remote staff for dynamic and
growing healthcare facilities. Leveraging our extensive global network, we connect clients with highly
qualified professionals, offering meticulously tailored services to meet our clients unique business
needs.
Utilisation Review Nurse
Role Purpose & Accountabilities
We are seeking a highly skilled Utilization Review Nurse to join our team. The ideal candidate will be a
PhRN with obligatory utilization review experience. Wound care experience is
preferable.
The role demands high attention to detail, excellent spoken and written English, and the ability to
analyze discrepancies in provided information. This position is instrumental in ensuring clinical
documentation integrity in accordance with ICD-10-CM coding guidelines, internal protocols, and CMS
guidance.
Responsibilities
Clinical Documentation Improvement: Conduct medical record reviews to ensure compliance,
completeness, and accuracy for severity of illness, risk, and quality using documentation strategies.
Identify opportunities for documentation improvement with strong critical-thinking skills.
Advanced Therapy Patient Management: Oversee the full lifecycle of advanced therapy patients,
including identification, patient progress monitoring, billing/coding, reimbursement, and payment for
associated products.
Compliance and Guidelines: Stay current on ICD-10-CM coding guidelines, AHA Coding Clinic Guidance,
and CMS Risk Adjustment guidance. Report non-compliance issues and assist in corrective action
planning.
State Reports and Compliance: Oversee state reports, logs, and vaccines to ensure compliance.
Perform other duties as assigned.
Required Skills & Experience
Utilization review & wound care experience is required. CDI or risk adjustment coding/auditing
experience is preferred.
Analytical Skills: Strong critical reasoning, decision-making, and problem-solving skills to analyze
situations and make sound judgments.
Organizational Skills: Excellent attention to detail and organizational skills to manage multiple tasks,
meet short deadlines, and handle frequent interruptions.
Communication: Effective verbal and written communication skills, including the ability to present
ideas and concepts effectively to providers, management, and team members. Good spoken and
written English is essential.
Qualificatons
Philippine Registered Nurse
Hours:
US Eastern Standard Time (EST) - 9 AM to 6 PM
About Limitlessli
We embrace the flexibility and convenience of a remote working environment, and you will collaborate
with an international team while contributing to our growing business, all from the comfort of your
home.
Essential requirements:
You will need to have some essential tools a reliable computer and noise-canceling headset, a second
monitor for enhanced productivity, and a stable internet connection. You'll also be required to have a
backup internet connection, ensuring that you're well-equipped to complete your work seamlessly.
Job Type: Full-time
Pay: Php45,
- 00 - Php55,000.00 per month
