Remote RN - Behavioral Health Utilization & Care Coordination

HealthEdge Software, Inc.; Northern (KY); Hybrid; USD 65,000 - 85,000; Full time

Job summary

HealthEdge is seeking a Registered Nurse to coordinate utilization/benefit management for health plans in a remote US role. The candidate will review authorizations, coordinate care plans, and communicate with providers to ensure medical necessity and appropriate levels of care.

Strong clinical judgment and regulatory knowledge are essential. The role emphasizes collaboration across time zones in a hybrid/remote work setting, with emphasis on documentation, education, and care coordination

Qualifications

• Registered Nurse with current unrestricted RN license.
• Certification in Case Management preferred based on department assignment.
• Continuous learning per company philosophy is required.

Responsibilities

• Coordinate and document utilization/benefit management for members.
• Review and approve requests for authorization of services.
• Prepare documentation for retrospective reviews and appeals.
• Coordinate discharge planning with internal and external partners.
• Educate providers about policies, benefits, and procedures.
• Communicate with providers to facilitate care and treatment.

Skills

Communication skills

Microsoft Office

Clinical criteria application

Regulatory knowledge

Interpersonal skills

Education

RN license

Case management certification (preferred)

Tools

EHR systems

Job description

HealthEdge is seeking a Registered Nurse to coordinate utilization/benefit management for health plans in a remote US role. The candidate will review authorizations, coordinate care plans, and communicate with providers to ensure medical necessity and appropriate levels of care.

Strong clinical judgment and regulatory knowledge are essential. The role emphasizes collaboration across time zones in a hybrid/remote work setting, with emphasis on documentation, education, and care coordination