Remote RN, Utilization Review & Care Management

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

Job summary

Intermountain Health is seeking an RN Utilization Review Care Management I for remote/part-time work. The role focuses on utilization review, cost-effective and high-quality care, with collaboration among patients, families, providers, and insurers.

8-hour schedule and campus-wide shifts are described, with required Teams video interview. The position requires active RN licensure with compact licensure, BSN within four years of hire, and experience in care management or related fields.

Qualifications

• Current RN license in state of practice with compact licensure.
• BSN required; obtain BSN within four years of hire/promotion.
• Experience in care management/navigation or related field including Utilization Management.
• Inpatient nursing experience; familiarity with hospital terminology and processes.
• Understanding of disease management and barriers to care, with strong communication skills.
• Ability to work independently in a dynamic environment.

Responsibilities

• Review and investigate medical records to ensure appropriate benefit utilization and medical necessity.
• Apply guidelines (e.g., InterQual/MCG) for prior authorization and post-service reviews.
• Adhere to regulatory guidelines and communicate timely with members and providers.
• Engage with providers to ensure safe, efficient care and appropriate settings.
• Collaborate with physicians and staff to expedite authorizations and referrals.
• Guide UM LPN & non-clinical staff on process and resource use.
• Resolve queries about authorizations and treatment plans.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Diagnosis

Medical Terminology

Time Management

Problem Solving

Quality Care

Communication

Education

BSN

Tools

Microsoft Office

Job description

Intermountain Health is seeking an RN Utilization Review Care Management I for remote/part-time work. The role focuses on utilization review, cost-effective and high-quality care, with collaboration among patients, families, providers, and insurers.

8-hour schedule and campus-wide shifts are described, with required Teams video interview. The position requires active RN licensure with compact licensure, BSN within four years of hire, and experience in care management or related fields.