Remote Benefit Review RN – Utilization & Care

Imagine360, LLC; United States; On-site; USD 80,000 - 100,000; Full time

Benefits offered by this job

Health plan options

Tuition reimbursement

Paid time off – 20 days

401k company contribution

Life insurance

Professional development opportunities

Job summary

Imagine360, LLC is seeking a Benefit Review RN to perform benefit reviews and utilization reviews under group health plans. The role supports coordination with case management, physician advisor referrals, and documentation in CaseTrakker, while maintaining HIPAA compliance and ongoing professional licensure.

The position emphasizes professional communication with physicians and healthcare teams, participation in trainings, and adherence to internal policies and regulatory requirements.

Qualifications

• Graduate of an accredited nursing program.
• 1+ year of utilization management experience.
• Experience with CPT and ICD coding.

Responsibilities

• Complete benefit reviews using Imagine360's clinical guidelines and policies.
• Collaborate with case management support to finalize the benefit review process.
• Staff medically complex cases with the Supervisor/Manager, Case Management.
• Document accurately in CaseTrakker and other software.
• Identify cases for Physician Advisor review and facilitate independent reviews.
• Review high-cost pharmacy reports to identify referrals to Case Management.

Skills

MS Office

HIPAA compliance

Education

RN - Accredited Nursing Program

Tools

CaseTrakker

Job description

Imagine360, LLC is seeking a Benefit Review RN to perform benefit reviews and utilization reviews under group health plans. The role supports coordination with case management, physician advisor referrals, and documentation in CaseTrakker, while maintaining HIPAA compliance and ongoing professional licensure.

The position emphasizes professional communication with physicians and healthcare teams, participation in trainings, and adherence to internal policies and regulatory requirements.