Remote RN: Utilization & Care Coordination

Evry Health; United States; On-site; USD 85,000 - 110,000; Full time

Benefits offered by this job

Competitive salary

Health, dental, vision insurance

Life and disability insurance

Retirement plan with company match

Generous time off and professional dev

Job summary

Evry Health is hiring an RN Integrated Care Coordinator (UM) to deliver comprehensive care coordination and drive quality outcomes for members. You will collaborate with clinicians, providers, and facilities to ensure a positive member experience while supporting utilization management decisions.

This is a remote role with rotating weekend hours. The ideal candidate has RN licensure in TX or a compact state, 1–5 years of clinical/utilization management experience, and familiarity with CPT/ICD-10

Qualifications

• Current, unrestricted US RN license (TX or Compact) required.
• 1–2 years in health plan utilization management preferred.
• Diploma from an accredited nursing program required.
• 3–5 years clinical experience in hospital/ambulatory setting desired.
• Familiarity with CPT/ICD-10 terminology and medical policy helpful.

Responsibilities

• Prepare clinical reviews based on guidelines and policies for physician review.
• Conduct prior auth, concurrent and retrospective reviews emphasizing utilization management.
• Monitor quality of care issues and escalate appropriately.
• Gather clinical information from facilities/providers to support medical necessity reviews.
• Assist with coding, medical records, pre-certification, reimbursement, and denials/appeals.

Skills

Utilization management

Care coordination

Clinical decision support

Communication

Team collaboration

Virtual work

CPT/ICD-10 knowledge

Patient engagement

Education

Nursing diploma

Texas license / Compact license

CCM or ACM certification

MCG certification

Tools

Salesforce

Healthcloud

CareIQ

Job description

Evry Health is hiring an RN Integrated Care Coordinator (UM) to deliver comprehensive care coordination and drive quality outcomes for members. You will collaborate with clinicians, providers, and facilities to ensure a positive member experience while supporting utilization management decisions.

This is a remote role with rotating weekend hours. The ideal candidate has RN licensure in TX or a compact state, 1–5 years of clinical/utilization management experience, and familiarity with CPT/ICD-10