Transplant Utilization Review RN - Hybrid/Remote

Quantum Health, Inc.; Poland; Hybrid; PLN 120,000 - 180,000; Full time

Job summary

Quantum Health, Inc. seeks a Transplant Nurse, Utilization Review to review inpatient transplant requests and coordinate discharge planning across facilities. This role emphasizes clinical decision making within established plan language and criteria, ensuring timely processing of authorizations while collaborating with providers and patients.

The position requires current licensure, hospital experience, and strong communication skills to support cost-effective, quality care for our members.

Qualifications

• Must hold an active, unrestricted professional license in an applicable clinical discipline.
• Two years of clinical hospital experience with direct patient care preferred.
• Ability to make timely decisions aligned with business goals.

Responsibilities

• Assess transplant inpatient requests against plan language and criteria.
• Conduct initial, concurrent, and retrospective clinical reviews.
• Document outcomes in authorization database using standard workflows.
• Coordinate discharge planning with providers and facilities.
• Communicate results to patients, providers, and internal teams to promote value-based care.
• Prepare high-quality medical reviews for MD collaboration.

Skills

Verbal and written communication

Critical thinking

Independent work

Multitasking

Team collaboration

Clinical decision making

Education

Active professional license (RN/LCSW/LPC/PharmD)

Multistate license (MSL) where applicable

Hospital patient-care experience

Job description

Quantum Health, Inc. seeks a Transplant Nurse, Utilization Review to review inpatient transplant requests and coordinate discharge planning across facilities. This role emphasizes clinical decision making within established plan language and criteria, ensuring timely processing of authorizations while collaborating with providers and patients.

The position requires current licensure, hospital experience, and strong communication skills to support cost-effective, quality care for our members.