Remote RN: Utilization Review & Care Management

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

Benefits offered by this job

Flexible work options

PEAK program

Comprehensive benefits

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for fully remote work. This role focuses on utilization review screenings, assessments, and evaluations to promote cost-effective, high-quality care, collaborating with patients, families, providers, and payers to ensure compliant and efficient processes.

The position requires an RN license with compact license, a BSN within four years, inpatient nursing experience, and strong communication.

Qualifications

• Current RN license in state of practice with compact licensure within service area.
• BSN from an accredited institution; must obtain BSN within four years of hire.
• Experience in care management/navigation or related fields including Utilization Management.
• Inpatient hospital nursing experience with familiarity to hospital terminology and processes.
• Strong written, verbal communication and conflict resolution skills.
• Proficiency with Microsoft Office and ability to troubleshoot computer/monitor setups.

Responsibilities

• Review and investigate medical records to determine appropriate benefit utilization and medical necessity.
• Apply evidence-based guidelines (InterQual/MCG) and policies for prior authorization and post-service reviews.
• Follow regulatory guidelines (NCQA, CMS, state, plan) with timely, clear communication to members and providers.
• Engage with providers to ensure safe, efficient medical care and appropriate care setting.
• Collaborate with physicians, staff, members and families to expedite authorizations and direct to medically necessary care.
• Engage with members/providers for safe transitions of care and authorization determinations.
• Resolve queries regarding authorizations, treatment plans, and medical necessity determinations.
• Mentor UM LPN & non-clinical staff on processes and resources.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN (Bachelor of Science in Nursing)

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for fully remote work. This role focuses on utilization review screenings, assessments, and evaluations to promote cost-effective, high-quality care, collaborating with patients, families, providers, and payers to ensure compliant and efficient processes.

The position requires an RN license with compact license, a BSN within four years, inpatient nursing experience, and strong communication.