Remote RN: Utilization & Care Management Pro

Intermountain Healthcare Inc.; San Juan (PR); Remote; USD 57,000 - 86,000; Part time

Benefits offered by this job

Generous benefits package

PEAK tuition program

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for remote, part-time work. You will review medical records, apply guidelines, and coordinate with providers to ensure appropriate, cost-effective care across enterprise regions.

Strong clinical nursing background and communication skills are required. Responsibilities include collaboration with patients, families, and payers; adherence to regulatory guidelines; and mentoring LPN/non-clinical staff.

Qualifications

• RN licensure in state of practice and compact licensure within service area.
• BSN from an accredited institution; degree verification required.
• Experience in care management/navigation or related field including Utilization Management, discharge planning, managed care.
• Clinical nursing experience in inpatient hospital setting; familiarity with hospital terminology.

Responsibilities

• Review and investigate medical records; apply clinical expertise for utilization review and medical necessity.
• Apply evidence-based guidelines (InterQual/MCG) for prior authorization and post-service reviews.
• Follow regulatory guidelines (NCQA, CMS, State, plan) with timely communication.
• Engage with providers to ensure safe, efficient care and appropriate care setting.
• Collaborate with physicians, staff, members, and families to expedite authorizations.
• Engage with members/providers for continuity of care and authorization determinations.
• Resolve queries regarding authorizations, treatment plans, and medical necessity.
• Mentor UM LPN and non-clinical staff on processes.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

RN Licensure (compact)

BSN degree

Tools

Microsoft Office

Microsoft Teams

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for remote, part-time work. You will review medical records, apply guidelines, and coordinate with providers to ensure appropriate, cost-effective care across enterprise regions.

Strong clinical nursing background and communication skills are required. Responsibilities include collaboration with patients, families, and payers; adherence to regulatory guidelines; and mentoring LPN/non-clinical staff.