Remote RN Utilization & Care Management Specialist

Intermountain Healthcare Inc.; Boise (ID); Remote; USD 57,000 - 86,000; Part time

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for a fully remote role. The position involves screening, assessing, and evaluating utilization review activities with emphasis on cost-effective, high-quality care.

You will collaborate with patients, families, providers, and insurers to ensure compliant and efficient reviews. Required RN licensure with compact licensure, BSN within four years of hire, and experience in care management or utilization.

Qualifications

• Current RN license in state of practice with compact licensure in service area.
• BSN within four years of hire or promotion; degree verification required.

Responsibilities

• Reviews and investigates medical records and applies clinical expertise to ensure appropriate benefit utilization and medical necessity.
• Uses guidelines (InterQual/MCG) and policies for prior authorization and post-service reviews.
• Adheres to regulatory guidelines and communicates timely with members, providers, and partners.
• Engages with providers to ensure safe, efficient care and appropriate disposition of services.
• Collaborates with physicians, staff, members, and families to expedite authorizations and direct to appropriate care settings.
• Resolves queries regarding authorizations, treatment plans, and medical determinations.
• Mentors UM LPN and non-clinical team on processes and resource use.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for a fully remote role. The position involves screening, assessing, and evaluating utilization review activities with emphasis on cost-effective, high-quality care.

You will collaborate with patients, families, providers, and insurers to ensure compliant and efficient reviews. Required RN licensure with compact licensure, BSN within four years of hire, and experience in care management or utilization.