Part-Time Remote RN: Utilization Review & Care Manager

Intermountain Healthcare Inc.; Richmond (VA); Remote; USD 57,000 - 86,000; Part time

Benefits offered by this job

Benefits package

PEAK program

Job summary

Intermountain Health seeks an RN Utilization Review Care Management I for a fully remote, part-time role. You will use clinical expertise to perform utilization review screenings, assessments, and evaluations, developing plans that promote cost-effective, high-quality care in collaboration with patients, families, providers, and payers.

Qualifications include an active RN license with compact licensure, BSN within four years, and experience in care management.

Qualifications

• RN license with compact licensure required.
• BSN within four years of hire/promotion required.
• Care management/navigation experience preferred.
• Experience with utilization management and hospital policies is advantageous.

Responsibilities

• Reviews and investigates medical records to ensure medical necessity and appropriate benefit utilization.
• Applies evidence-based guidelines (e.g. InterQual/MCG) for prior authorization and post‑service reviews.
• Adheres to regulatory guidelines and communicates clearly with members, providers, and partners.
• Proactively engages with providers to ensure safe, efficient care and appropriate setting for services.
• Resolves queries regarding authorizations, treatment plans, and medical necessity determinations.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Terminology

Time Management

Communication

Education

RN license with compact licensure

BSN within four years

Job description

Intermountain Health seeks an RN Utilization Review Care Management I for a fully remote, part-time role. You will use clinical expertise to perform utilization review screenings, assessments, and evaluations, developing plans that promote cost-effective, high-quality care in collaboration with patients, families, providers, and payers.

Qualifications include an active RN license with compact licensure, BSN within four years, and experience in care management.