Remote RN Utilization & Care Management Specialist

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

Benefits offered by this job

PEAK tuition program

Comprehensive benefits package

Job summary

Intermountain Health’s St. Marys Regional Hospital in Colorado seeks an RN Utilization Review Care Management I for remote, part-time work. You will review medical records, apply evidence-based guidelines, and collaborate with providers, members, and payers to ensure appropriate care and authorization decisions.

Requires compact RN licensure, BSN within 4 years, and inpatient nursing experience. Schedule includes 8:00–5:00, with enterprise-wide coverage.

Qualifications

• Current RN license in state of practice with compact licensure.
• BSN from an accredited program; must obtain BSN within four years of hire.
• Experience in care management/navigation or related field including Utilization Management.
• Inpatient hospital nursing experience.
• Knowledge of disease management and barriers to care.
• Strong written and verbal communication; conflict resolution.

Responsibilities

• Reviews and investigates medical records and applies clinical expertise to assure appropriate benefit utilization and medical necessity.
• Uses guidelines (InterQual/MCG) 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 settings.
• Collaborates with physicians, staff, and members to expedite authorization and appropriate care.
• Resolves queries regarding authorizations and medical necessity determinations.
• Mentors UM LPN and non-clinical staff on process and resources.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

RN Licensure (Compact)

Job description

Intermountain Health’s St. Marys Regional Hospital in Colorado seeks an RN Utilization Review Care Management I for remote, part-time work. You will review medical records, apply evidence-based guidelines, and collaborate with providers, members, and payers to ensure appropriate care and authorization decisions.

Requires compact RN licensure, BSN within 4 years, and inpatient nursing experience. Schedule includes 8:00–5:00, with enterprise-wide coverage.