Remote Behavioral Health RN — Care Coordination

HealthEdge; United States; Remote; USD 65,000 - 85,000; Full time

Job summary

HealthEdge is seeking a Telephonic Utilization Management RN to coordinate, document, and communicate all aspects of the utilization/benefit management program. You will assess clinical needs, review authorization requests, and ensure care plans align with medical necessity across inpatient and outpatient settings.

The role requires RN licensure, 2+ years acute clinical experience, and familiarity with managed care.

Qualifications

• Registered Nurse with an unrestricted RN license; certification in Case Management preferred.
• Minimum 2+ years of acute clinical experience as an RN.
• One year health insurance plan or managed care experience preferred.
• 1+ years Behavioral Health clinical experience.
• 1+ years Managed Care of Utilization Management experience.

Responsibilities

• Assess, plan, coordinate, monitor and evaluate options to facilitate appropriate healthcare services and benefits for members.
• Review and authorize requests for authorization of elective, direct, ancillary, urgent, or emergency services.
• Analyze documentation related to retrospective review requests and appeals per standards.
• Coordinate discharge planning with internal and external entities.
• Resolve issues related to benefits, member eligibility, and care coordination.

Skills

Communication skills

Customer service

Clinical guidelines

Accreditation standards

Education

RN license

Tools

Microsoft Office Suite

Job description

HealthEdge is seeking a Telephonic Utilization Management RN to coordinate, document, and communicate all aspects of the utilization/benefit management program. You will assess clinical needs, review authorization requests, and ensure care plans align with medical necessity across inpatient and outpatient settings.

The role requires RN licensure, 2+ years acute clinical experience, and familiarity with managed care.