Remote RN Utilization & Care Management Specialist

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

Benefits offered by this job

Generous benefits package

PEAK program tuition coverage

Job summary

Intermountain Health in Grand Junction, Colorado, seeks an RN Utilization Review Care Management I for a part-time, fully remote role. You will evaluate medical necessity, authorize services, and guide care using evidence-based guidelines. Video interview via Teams is required.

The position requires an RN license (compact preferred), a BSN within four years of hire, and experience in care management. Remote work options and a generous benefits package are offered.

Qualifications

• RN licensure in state of practice and compact licensure within service area.
• BSN within four years of hire or promotion date.
• Experience in care management/navigation or related field.
• Clinical nursing experience in inpatient hospital setting.

Responsibilities

• Reviews and investigates medical records to assure appropriate benefit utilization and medical necessity.
• Applies evidence-based guidelines for prior authorization and post-service reviews.
• Communicates with members, providers, and partners per regulatory guidelines.
• Engages with providers to ensure safe and efficient medical care and transitions.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis & Treatment

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

RN licensure (compact)

Job description

Intermountain Health in Grand Junction, Colorado, seeks an RN Utilization Review Care Management I for a part-time, fully remote role. You will evaluate medical necessity, authorize services, and guide care using evidence-based guidelines. Video interview via Teams is required.

The position requires an RN license (compact preferred), a BSN within four years of hire, and experience in care management. Remote work options and a generous benefits package are offered.