Remote RN Utilization Review Care Manager

Intermountain Healthcare Inc.; Cheyenne (WY); Remote; USD 56,000 - 86,000; Part time

Job summary

Intermountain Health seeks an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role involves collaboration with patients, families, providers, and insurers to ensure compliant, efficient services.

We offer flexible work options where approved. The position requires compact licensure and RN BSN within four years, with 8:00 AM–5:00 PM hours and enterprise-wide shift coverage.

Qualifications

• Current RN license in state of practice with compact licensure.
• BSN required; BSN must be obtained within four years of hire/promotion.
• Experience in care management/utilization management or related field.
• Inpatient hospital nursing experience and familiarity with hospital terminology.
• Strong written and verbal communication and conflict resolution skills.

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.
• Communicate findings clearly to members and providers per regulatory guidelines.
• Engage with providers to ensure safe, efficient care and appropriate care settings.
• Mentor UM LPNs and non-clinical staff on process and resources.

Skills

Utilization Management

Clinical Expertise

Investigative Acumen

Medical Terminology

Time Management

Communication

Education

BSN

Tools

Microsoft Teams

Outlook

Microsoft Office

Job description

Intermountain Health seeks an RN Utilization Review Care Management I to perform utilization review screenings, assessments, and evaluations with a focus on cost-effective, high-quality care. The role involves collaboration with patients, families, providers, and insurers to ensure compliant, efficient services.

We offer flexible work options where approved. The position requires compact licensure and RN BSN within four years, with 8:00 AM–5:00 PM hours and enterprise-wide shift coverage.