Remote RN – Physical Health Utilization Specialist

Alliance Health in; Morrisville (NC); A distancia; USD 70.000 - 89.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Generous retirement plan

Hybrid/Remote options

Paid time off

Dress flexibility

Descripción de la vacante

Alliance Health is seeking an UM Clinical Specialist RN-Physical Health (Remote, NC Based) to assess medical necessity and oversee reviews across inpatient, outpatient, and elective services. The role emphasizes remote work with occasional in-office meetings.

The candidate should hold an active NC RN license with 3–5 years of nursing experience and prior Utilization Management exposure. Strong communication and documentation skills are essential for success.

Formación

• Current, active NC RN license (compact allowed).
• 3–5 years nursing experience in clinical settings.
• Experience in Utilization Management or healthcare operations.
• Strong written and oral communication skills.
• Proficiency with Microsoft Office and clinical documentation.

Responsabilidades

• Assess medical necessity of services and ensure alignment with guidelines.
• Conduct pre-certification, concurrent, and retrospective reviews.
• Communicate with members and providers and respond to adverse determinations.
• Collaborate with departments to integrate Utilization Management processes.

Conocimientos

Analytical skills

Communication skills

Clinical assessment

Utilization Management knowledge

Educación

Bachelors degree in Nursing

RN license (NC)

Herramientas

Microsoft Office Expert

Clinical documentation

Descripción del empleo

Alliance Health is seeking an UM Clinical Specialist RN-Physical Health (Remote, NC Based) to assess medical necessity and oversee reviews across inpatient, outpatient, and elective services. The role emphasizes remote work with occasional in-office meetings.

The candidate should hold an active NC RN license with 3–5 years of nursing experience and prior Utilization Management exposure. Strong communication and documentation skills are essential for success.