Registered Nurse (RN) | Utilization Review Coordinator

These recordings may be reviewed by authorized company personnel and may be processed using artificial intelligence or automated tools to assist with notetaking, transcription, scheduling, candidate evaluation support, and other recruiting functions. Familiarity with Medicare, Medicaid, or commercial payer coverage criteria for DME, home oxygen, positive airway pressure (PAP) therapy, or other respiratory equipment.

Registered Nurse (RN) | Utilization Review Coordinator
VieMed · Full-time · Fully in-office
Starting pay is $35 per hour
Monday through Friday, 8 a.m. to 5 p.m.

Use your nursing judgment to help patients access prescribed respiratory therapies, durable medical equipment (DME), and supplies. As a Utilization Review Coordinator at VieMed, you’ll review clinical records, connect the findings to the provider’s order, and work with intake teams and provider offices to resolve documentation gaps. Your reviews will help determine when a referral is ready to move forward and what’s needed when it isn’t.

This position is fully in-office and will remain on-site. Weekend work, overtime, or on-call coverage may be required based on business needs.
What you’ll do

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  Review provider orders, progress notes, histories and physicals, diagnostic results, hospital records, and other referral documentation.
  
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  Apply nursing judgment to assess whether diagnoses, symptoms, treatment history, and clinical findings support the medical necessity of the requested therapy, equipment, or supplies.
  
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  Identify missing, incomplete, conflicting, or unclear documentation. Communicate specific gaps and request clarification from the appropriate parties.
  
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  Recommend whether referrals are ready to proceed, what additional documentation is needed, and what steps should come next.
  
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  Evaluate documentation against applicable Medicare, Medicaid, and commercial payer coverage requirements before submission for reimbursement.
  
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  Record review findings, documentation gaps, recommendations, and referral status in the designated system.
  
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  Escalate complex clinical questions, documentation concerns, and potential compliance issues to the Intake Manager, Intake Supervisor, or appropriate leader.
  
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  Follow applicable regulations, payer requirements, and VieMed Intake, Billing, and Compliance procedures. Support other assigned duties and projects.
  

Required qualifications

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  Current, active Registered Nurse (RN) license in good standing.
  
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  Clinical nursing experience and demonstrated ability to review medical records, interpret provider documentation, and apply sound clinical judgment.
  
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  Working knowledge of medical terminology, common respiratory therapies, and durable medical equipment.
  
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  Understanding of health insurance concepts and the ability to learn and apply Medicare, Medicaid, and commercial payer documentation requirements.
  
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  Strong attention to detail and the ability to explain what is missing, inconsistent, or insufficient in a clinical record.
  
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  Clear written and verbal communication with physicians, other healthcare providers, insurers, patients, colleagues, and leadership.
  
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  Ability to manage multiple chart reviews, prioritize work, meet turnaround expectations, and maintain accurate records.
  
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  Ability to work independently, collaborate across departments, and demonstrate professionalism, accountability, and initiative.
  
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  Proficiency with electronic medical records, patient and referral databases, and Microsoft Outlook, Word, and Excel.
  

Preferred qualifications

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  Experience in utilization review, utilization management, prior authorization, clinical appeals, or medical necessity review.
  
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  Familiarity with Medicare, Medicaid, or commercial payer coverage criteria for DME, home oxygen, positive airway pressure (PAP) therapy, or other respiratory equipment.
  
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  Experience reviewing provider orders and supporting records for authorization or reimbursement and working with provider offices to resolve documentation gaps.
  
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  Experience in discharge planning, case management, home health, or another clinical setting that involves coordinating home oxygen, respiratory equipment, or other DME.
  

RNs with strong chart review skills and relevant experience in direct patient care or care coordination are encouraged to apply.
Privacy and employment information
This role handles protected health information (PHI). Employees must follow company privacy and security policies and applicable HIPAA requirements when accessing, documenting, or sharing patient information.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position. Duties and responsibilities may change based on business needs.

VieMed is an equal opportunity employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other characteristic protected by law.

By submitting your application and participating in the interview process, you acknowledge and consent that interviews, video meetings, phone screenings, and other recruiting interactions may be recorded for evaluation, training, quality assurance, compliance, and hiring purposes. These recordings may be reviewed by authorized company personnel and may be processed using artificial intelligence or automated tools to assist with notetaking, transcription, scheduling, candidate evaluation support, and other recruiting functions. No employment decision will be based on automated processing. Recording and processing are subject to applicable laws and company privacy policies.
**VHS is an Equal Opportunity Employer (“EEO”)/Protected Veterans/Individuals with Disabilities/E-Verify Employer and welcomes all to apply** #LiveYourLife