Nurse Case Reviewer for Medical Transportation Coordination

Overview

Alacura is a leading medical transportation benefit management company specializing in coordinating and reviewing both ground and air ambulance services for healthcare plan members. Our team of experienced Utilization Management Nurses plays a critical role in helping patients navigate and utilize their medical benefits effectively. By evaluating clinical needs and coordinating appropriate transportation solutions, our nurses ensure that every patient receives timely, medically necessary transport aligned with payer guidelines. This is a hybrid position with the majority of work performed remotely on a computer. We're seeking a highly skilled RN with a background in ICU, critical care or emergency department settings, nurses who can apply their critical thinking and clinical judgment to assess complex patient needs across a wide range of medical conditions.

Work Location: Hybrid remote in Dallas, TX Must live within range to be able to come into the office when needed for education and training, Training is required at our Dallas office. After training, this is primarily a work-from-home (WFH) position, contingent on maintaining productivity standards.

Requirements: Registered Nurse. Must have ICU, ED or critical care experience. Past office work, knowledge of claims or insurance is a plus but not mandatory.

Who is a good candidate: The ideal candidate for this role is a Registered Nurse with a strong clinical foundation in ICU, Emergency Department, or Critical Care settings who is ready to transition into a professional, fast-paced, non-bedside role. Is comfortable working independently on a computer-based platform and can manage time effectively in a remote work environment.

This is a great fit for a nurse looking to step away from direct patient care while still making a clinical impact in a supportive, collaborative environment.

Duties

UM NURSE COORDINATOR

· Receive cases for review within Alacura's Utilization Management software for identified clients. These cases can be prospective, concurrent, or retrospective in nature. Review of clinical information and medical necessity against evidence-based criteria, and review cases within set timeframes.

· Receives transfer requests from referring facilities for patients with emergent and urgent medical conditions.

· Obtains a comprehensive understanding of the patient's medical condition.

· Applies approved clinical criteria to evaluate appropriateness of transfer and level of care. Documents findings based on department standards.

· Assists with clinical aspects of insurance precertification & authorizations for transportation.

· Assists with logistics involved in transporting patients.

· Coordinates with the aviation and ground dispatch personnel to identify the most appropriate servicing provider and crew to support the patient's transport needs and coordinates patient transfer to receiving facility

· Facilitates all communication between referring and receiving hospitals/physicians in a professional and effective manner. Provides follow-up calls and communications with both internal and external customers to ensure stakeholder's needs are met.

· Exemplifies highest level of customer service skills and etiquette with internal and external customers, striving to be friendly and helpful.

· Distributes surveys to all parties after completion of flight and updates provider database with results.

· Maintains knowledge base of processes and systems by attending meetings and reviewing training materials and identifies, addresses, and works to resolve system problems impacting transfers. Escalates issues as appropriate to management.

Schedule: Monday to Friday

Job Type: Full-time

Pay: $80,000.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Health insurance
• Health savings account
• Paid time off
• Tuition reimbursement
• Vision insurance

Work Location: Hybrid remote in Dallas, TX 75243